The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment*

Critical Care Medicine
Andrew LabelleMarin Kollef

Abstract

To identify the determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment. A retrospective cohort study of hospitalized patients with blood culture positive septic shock (January 2002-December 2007). Barnes-Jewish Hospital, a 1,250-bed urban teaching hospital. Four hundred thirty-six consecutive patients with septic shock and a positive blood culture. Data abstraction from computerized medical records. Septic shock was associated with bloodstream infection due to Gram-negative bacteria (59.2%) and Gram-positive bacteria (40.8%). Two hundred twenty-four patients (51.4%) died during their hospitalization. The presence of infection attributed to antibiotic-resistant bacteria was similar for patients who survived and expired (22.6% vs. 20.1%; p = .516). Multivariate logistic regression analysis demonstrated that infection acquired in the intensive care unit (adjusted odds ratio 1.99; 95% confidence interval 1.52-2.60; p = .011) and increasing Acute Physiology and Chronic Health Evaluation II scores (one-point increments) (adjusted odds ratio 1.11; 95% confidence interval 1.09-1.14; p < .001) were independently associated with a greater risk of hospital mortality, whereas ...Continue Reading

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