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The impact of empiric antimicrobial treatment and the clinical microbiological guidance in sepsis

Abstract number: 1733_894

Jensen U.S., Monnet D.L., Frimodt-Møller N., Knudsen J.D.

Objectives: The recommendations for antibiotic therapy are based on local findings of microorganisms and the resistance patterns found. The recommendations for empiric sepsis treatments are of especial importance for the outcome and of patients. The recommended empiric treatment for community-acquired sepsis with undocumented focus is cefuroxime, usually 1.5 g tid, together with gentamicin 3–5 mg/kg od (for max three days), and metronidazole 500 mg tid if an abdominal focus is suspected.

Evaluation of the coverage of the recommended empiric treatment and the impact of microbiological guidance is sought by continuous electronic registration.

Materials and Methods: The findings in blood cultures at a centralised clinical microbiology laboratory serving 2,500 beds in 5 somatic hospitals in Copenhagen were electronically recorded together with information regarding the signs and symptoms and the treatment guidance given by the clinical microbiological consultants, in a new electronic recording system from January 2006. Only cases of sepsis with findings of significant microorganisms were included, and cases with coagulase negative staphylococci, Corynebacteria, and other possible less important findings were excluded. Only one episode per patient was included.

Results: In the six month period, Jan–Jun 2006, the findings of a total of 582 sepsis patients were considered significant, and the electronic records were evaluated for 362 (70%) of these patients. The overall 30 days mortality was 18%, varying from 62% for fungaemia, and 8% for pneumococcus sepsis, respectively. Escherichia coli was the most frequent finding, in 39% of all cases, followed by Staphylococcus aureus in 10% and Pneumococcus in 9%. Among the E. coli, 98% were fully susceptible to cefur, 5% of the Pneumococci were intermediate susceptible to penicillin, and all S. aureus were MSSAs. Cefur alone covered 77% of the blood culture findings. The guidance by the consulting microbiologist modified the treatments if necessary, in almost all cases within two days after the blood cultures were drawn. The group of patients (N = 277) with bacteria in blood cultures susceptible for cefuroxime had a significantly better outcome with 30 days mortality of 16% compared to patients (N = 64) with bacteria not susceptible to cefur (Fisher's exact test, p = 0.03).

Conclusions: The coverage of the empiric antimicrobial treatment was sufficient and clinical microbiological guidance had a major impact on the outcome of bacteraemia.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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