Prognostic factors of community-acquired severe sepsis and septic shock

Abstract number: P960

Artero A., Zaragoza R., Camarena J., Sancho S., González R., Nogueira J.

Objective: We sought to determine the independent risk factors on mortality in community acquired bacteraemic patients with severe sepsis and septic shock.

Methods: A single-site prospective cohort study in a medical-surgical ICU in an academic tertiary

care centre. Seventy patients with community acquired bacteraemic severe sepsis and septic shock were identified. Clinical, microbiologic and laboratory parameters were compared between hospital survivors and hospital deaths.

Results: The global mortality rate was 50%, 52.8% in septic shock and 41.2% in severe sepsis. One o more comorbidities was present in 64.3% of patients. The most commonly identified bloodstream pathogen was Escherichia coli (24.3%). Gram-positive microorganisms were isolated in 51.4% of blood cultures. The proportion of patients receiving inadequate antimicrobial treatment was 7.1%. By univariate analysis, age, APACHE II score, 3 or more organ dysfunctions, and albumin, but neither inadequate empirical antimicrobial treatment nor microbiologic characteristics nor site of infection, differed significantly between survivors and non-survivors. APACHE II (OR: 1.19; 95% CI: 1.08–1.31) and albumin (OR: 0.13; 95% CI: 0.04–0.44) were independent risk factors associated with global mortality in logistic regression analysis.

Conclusions: APACHE II score and low levels of albumin were independently associated with increased mortality. Our results support that inadequate empirical antimicrobial treatment is not a significant factor to outcome in community acquired severe sepsis and septic shock in standard clinical setting.