engleski

The impact of ICU performance and empirical antimicrobial therapy on sepsis outcome

Introduction. Paper evaluated epidemiology of sepsis in medical intensive care unit (ICU), and the impact of ICU performance and adequate empirical antibiotic therapy on survival. Methods. Observational, prospective study assessed all patients (pts) meeting criteria for sepsis at admission. Clinical presentation of sepsis was defined according to 2001 International sepsis definitions conference. Demographic and epidemiology data, severity of sepsis, ICU/hospital stay, outcome, performance and appropriateness of empirical antibiotic therapy were analyzed. Results. The study included 314 (6.3%) pts, predominantly male, median age 71, 176 (56.1%) ICU survivors and 138 (43.9%) non-survivors. The non-survivors were older, with limited mobility and predominantly male (p<0.001 ; p<0.001 ; p=0.030). There were more septic pts in the winter (p=0.013) with higher death rate (p=0.002). Mean length of stay was 6.97 days for ICU, and 15.82 days for hospital. Non-survivors had significantly lower GCS and higher APACHE II and SOFA scores (p<0.001 for all), and history of chronic heart (p<0.001), and respiratory (p<0.001) failure. At the ICU admission sepsis was present in 100 (31.8%), severe sepsis in 89 (28.6%), and septic shock in 125 (39.8%) pts with mortality rates 17%, 33.7%, 72.1% respectively. 244 (77.7%) pts developed at least one organ dysfunction syndrome, out of 138 (43.9%) pts who met criteria for septic shock, 107 (75.4) were non-survivors (p<0.001). Microbiological documentation of sepsis was obtained in 235 (74.8%) pts ; bloodstream infection was documented in 62 (19.8%), urinary in 65 (20.7%), and respiratory tract infection in 16 (5.1%) pts ; 86 (27.4%) had documented infection in bloodstream and focus, and 6 (1.9%) in two different focuses. Positive blood culture rate at admission was 49%, documented presence of bacteria in bloodstream was related to better outcome (p<0.001). Urinary tract infections were the most common 168 (53.5%), followed by skin/soft tissue 58 (18.5%), lower respiratory tract 44 (14.0%) and gallbladder/bile ducts 17 (5.4%) infections. Lower respiratory tract as focus of sepsis was connected with worse outcome (p<0.001). Empirical antibiotic treatment was considered adequate in 106 (60.5%) survivors and 42 (31.2%) non-survivors, and inadequate in 70 (39.5%) survivors and 96 (68.8%) non-survivors (p=<0.001). Patients treated with adequate empirical antibiotic therapy had significantly higher survival time in hospital (log-rank p=0.0011). Conclusion. Sepsis syndrome commonly occurs among vulnerable pts, such as elderly and pts with multiple comorbidities. ICU management and performance with aggressive resuscitation of septic pts, and prompt and appropriate empiric antimicrobial treatment is life saving. Severity of illness of this group of pts was underestimated in emergency department, which resulted in time delay in ICU admission that might be fatal.

sepsis; intensive care unit; performane; antimicrobial therapy; outcome

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