Antibiotic prescription patterns in the empiric therapy of severe sepsis: Combination of antimicrobials with different mechanisms of action reduces mortality

Ana Díaz-Martín, María L. Martínez-González, Ricard Ferrer, Carlos Ortiz-Leyba, Enrique Piacentini, Maria J. Lopez-Pueyo, Ignacio Martín-Loeches, Mitchell M. Levy, Antoni Artigas, José Garnacho-Montero, Ana Navas, María Álvarez, Josep Maria Sirvent, Sara Herranz Ulldemolins, Pedro Galdós, Goiatz Balziscueta, Pilar Marco, Izaskun Azkarate, Rafael Sierra, José Javier IzuaJosé Castaño, Alfonso Ambrós, Julian Ortega, Virgilio Corcoles, Luis Tamayo, Demetrio Carriedo, Milagros Llorente, Paz Merino, Elena Bustamante, Eduardo Palencia, Pablo García Olivares, Patricia Santa Teresa Zamarro, Carlos Pérez, Ana Renedo, Silvestre Nicolás-Franco, María Salomé Sánchez, Francisco Javier Gil, María Jesús Gómez, Ana Loza, Jordi Ibáñez, Silvia Rodríguez, Jose Ángel Berezo, Jesús Blanco, Angeles Gabán, M. Jesús López Cambra, Alec Tallet, Miguel Martínez, Jose Antonio Fernández, Fernando Callejo, M. Jesús López Pueyo, Francisco Gandía, M. José Fernández, Juan Carlos Ballesteros, María Teresa Antuña, Santiago Herrero, Manuel Valledor, M. Jose Gutierrez, Carmen Pérez, Oscar Rodríguez, Rafael Dominguez, Josefa Peinado, María Victoria de la Torre, Cristina Salazar, M. Cruz Martín, Joaquin Ramon, Fernando Iglesias Llaca, Lorena Forcelledo Espina, Francisco Taboada Costa, José Antonio Gonzalo Guerra, Francisco José Guerrero, Felipe Cañada, M. Milagros Balaguer, Isabel Mertín, Carmen López, Daniel Sánchez, Josep Costa, Calizaya, Angel Arenaza, Ana M. Morillo, Daniel Del Toro, Tomás Guzman, Antonio Blesa, Fernando Martínez, Alejandro Moneo, M. Jesús Broch, Jose Antonio Camacho, Francisco J. Garcia, Xosé Luis Pérez, Nieves Garcia, Juan Carlos Ruiz, Jesús Caballero, Esther Francisco, Tania Requena, Adolfo Ruiz, José Luis Bóveda, José Miguel Soto, Constantino Tormo, Rafael Blancas, Manuel Quintana, Miguel Ángel Taberna

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Abstract

Introduction: Although early institution of adequate antimicrobial therapy is lifesaving in sepsis patients, optimal antimicrobial strategy has not been established. Moreover, the benefit of combination therapy over monotherapy remains to be determined. Our aims are to describe patterns of empiric antimicrobial therapy in severe sepsis, assessing the impact of combination therapy, including antimicrobials with different mechanisms of action, on mortality.Methods: This is a Spanish national multicenter study, analyzing all patients admitted to ICUs who received antibiotics within the first 6 hours of diagnosis of severe sepsis or septic shock. Antibiotic-prescription patterns in community-acquired infections and nosocomial infections were analyzed separately and compared. We compared the impact on mortality of empiric antibiotic treatment, including antibiotics with different mechanisms of action, termed different-class combination therapy (DCCT), with that of monotherapy and any other combination therapy possibilities (non-DCCT).Results: We included 1,372 patients, 1,022 (74.5%) of whom had community-acquired sepsis and 350 (25.5%) of whom had nosocomial sepsis. The most frequently prescribed antibiotic agents were β-lactams (902, 65.7%) and carbapenems (345, 25.1%). DCCT was administered to 388 patients (28.3%), whereas non-DCCT was administered to 984 (71.7%). The mortality rate was significantly lower in patients administered DCCTs than in those who were administered non-DCCTs (34% versus 40%; P = 0.042). The variables independently associated with mortality were age, male sex, APACHE II score, and community origin of the infection. DCCT was a protective factor against in-hospital mortality (odds ratio (OR), 0.699; 95% confidence interval (CI), 0.522 to 0.936; P = 0.016), as was urologic focus of infection (OR, 0.241; 95% CI, 0.102 to 0.569; P = 0.001).Conclusions: β-Lactams, including carbapenems, are the most frequently prescribed antibiotics in empiric therapy in patients with severe sepsis and septic shock. Administering a combination of antimicrobials with different mechanisms of action is associated with decreased mortality. © 2012 Dias-Martin et al.; licensee BioMed Central Ltd.
Original languageEnglish
Article numberR223
JournalCritical Care
Volume16
Issue number6
DOIs
Publication statusPublished - 18 Nov 2012

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