Sepsis caused by bloodstream infection in patients in the intensive care unit: the impact of inactive empiric antimicrobial therapy on outcome

Brooks, D., Polubothu, P., Young, D., Booth, M.G. and Smith, A. (2018) Sepsis caused by bloodstream infection in patients in the intensive care unit: the impact of inactive empiric antimicrobial therapy on outcome. Journal of Hospital Infection, 98(4), pp. 369-374. (doi:10.1016/j.jhin.2017.09.031) (PMID:28993134)

Brooks, D., Polubothu, P., Young, D., Booth, M.G. and Smith, A. (2018) Sepsis caused by bloodstream infection in patients in the intensive care unit: the impact of inactive empiric antimicrobial therapy on outcome. Journal of Hospital Infection, 98(4), pp. 369-374. (doi:10.1016/j.jhin.2017.09.031) (PMID:28993134)

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Abstract

Background: Sepsis is one of the leading causes of death in the UK. Aims: The aims of this study were to identify the rate of inactive antimicrobial therapy (AMT) in the ICU and whether inactive AMT had an effect on in hospital mortality, ICU mortality, 90-day mortality and length of hospital stay. Additionally, we wanted to identify risk factors for receiving inactive AMT. Methods: This was a retrospective observational study conducted at Glasgow Royal Infirmary ICU between January 2010 and December 2013, with 12,000 blood cultures taken over this time period, of which n=127 were deemed clinically significant. Multivariate logistic regression was used to identify risk factors independently associated with mortality. To identify risk factors for receiving inactive AMT a univariable and a subsequent multivariate analysis was constructed. Results: The rate of inactive AMT was 47% (n =60). Our multivariate analysis showed that receiving antibiotics within the first 24 hours of ICU admission led to a reduced mortality (RR 1.70; 95% CI 1.19-2.44.) Furthermore, it showed that severity of illness (as defined by SIRS criteria sepsis vs septic shock) increased mortality (OR 9.87; 95% CI 1.73-55.5). However, inactive AMT did not increase mortality (OR 1.07; 95% CI 0.47-2.41) or length of hospital stay (53.2 vs 69.1 days p=0.348.) We identified fungal bloodstream infection as a risk factor for receiving inactive AMT (OR 5.10;95% CI 1.29-20.14. Conclusion: Mortality from sepsis is influenced by multiple factors. We were unable to demonstrates that inactive AMT had an effect on mortality in sepsis.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Booth, Dr Malcolm and Young, Professor Daniel and Smith, Professor Andrew
Authors: Brooks, D., Polubothu, P., Young, D., Booth, M.G., and Smith, A.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
Journal Name:Journal of Hospital Infection
Publisher:Elsevier
ISSN:0195-6701
ISSN (Online):1532-2939
Published Online:07 October 2017
Copyright Holders:Copyright © 2017 Elsevier
First Published:First published in Journal of Hospital Infection 98(4):369-374
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.

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