Abstract
Background
Antibiotic selection made within the first hour of recognition of severe sepsis and
septic shock has been shown to decrease mortality.
Objective
The purpose of this study was to determine what antibiotics are being prescribed and
to identify factors influencing ineffective antibiotic coverage in patients with severe
sepsis or septic shock. In addition, we explore an alternative method for antibiotic
selection that could improve organism coverage.
Methods
This was a retrospective review of emergency department (ED) patients admitted to
an intensive care unit (ICU) over a 12-month period with a culture-positive diagnosis
of either severe sepsis or septic shock. Appropriate antibiotic therapy was defined
as effective coverage of the offending organism based on final culture results.
Results
Of the 1400 patients admitted to the ICU, 137 patients were culture positive and met
the criteria for severe sepsis or septic shock. Effective antibiotic coverage was
prescribed by emergency physicians in 82% (95% confidence interval [CI] .74–.88) of
cases. Of the 25 patients who received ineffective antibiotics, the majority had infections
caused by resistant Gram-negative organisms. Health care-associated pneumonia guidelines
were applied to all patients, regardless of the source of infection, and were 100%
sensitive (95% CI .93–1) for selecting patients who had infections caused by highly
resistant organisms.
Conclusion
Emergency physicians achieved 82% effective antibiotic coverage in patients with severe
sepsis or septic shock. The gap seems to be in coverage of highly resistant Gram-negative
organisms. An alternative approach to antibiotic prescription, utilizing a set of
guidelines for community- and health care-associated infections, was found to be 100%
sensitive in selecting patients who had infections caused by the more resistant organisms.
Keywords
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Article info
Publication history
Published online: March 07, 2011
Accepted:
October 31,
2010
Received in revised form:
August 30,
2010
Received:
April 19,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
