"Appropriate" Versus "Inappropriate" Antibiotic Administration, "Prior To" Versus "After" the Diagnosis of Septic Shock. Impact on Patients with Sepsis Admitted to a Saudi Intensive Care Unit

• Published in: Materia socio-medica Vol. 32; no. 1; pp. 20 - 28
• Main Authors: Algethamy, Haifa M, Morish, Ayman, Numan, Mohammad S, Alotaibi, Abdullah F
• Format: Journal Article
• Language: English
• Published: Bosnia and Herzegovina Academy of Medical Sciences of Bosnia and Herzegovina 01.03.2020; AVICENA, d.o.o., Sarajevo
• Subjects: Antibiotics; Data collection; Demographics; Intensive care; Laboratories; Medical diagnosis; Mortality; Nosocomial infections; Original Paper; Patients; Sepsis; Skin; Ventilators; Saudi Arabia; United States > US; mortality; treatment; septic shock; antibiotics; sepsis
• ISSN: 1512-7680; 1986-597X
• DOI: 10.5455/msm.2020.32.20-28

Delaying broad-spectrum antibiotics beyond 1-2 hours once the septic shock is diagnosed increases patients' risk of death. However, what is the impact of already being on antibiotics when a septic shock is diagnosed? We compared demographics, clinical characteristics and outcomes in septic shock patients on antibiotics initiated prior to versus after septic shock was diagnosed; whose initial antibiotics were considered appropriate for the offending organism(s); and who died in versus were discharged from the ICU. Data were prospectively collected on 161 patients ≥ 14-years-old (female: male=1:1; mean age 61.1yrs) admitted to the ICU for septic shock, and followed for ≥30 days, or until hospital discharge or death. Few inter-group differences were identified. Those treated early were more likely to have a nosocomial infection (p=0.03), skin or soft tissue source of their infection (p=0.01), or a diabetes-related limb amputation (p=0.02); but received fewer antibiotics (p=0.01). Those on appropriate antibiotics were more likely to be female (p=0.048), but less likely to have a skin or soft tissue source of infection (p=0.03). Neither starting antibiotics early, nor being on appropriate antibiotics impacted any outcome measure, including survival. Predictors of mortality were ≥1 co-morbid condition (p=0.03), more versus fewer co-morbid conditions (p=0.009), cardiovascular disease at baseline (p=03), requiring dialysis at baseline (p=0.008), and a higher day#1 SOFA score (p<0.001). Our data fail to demonstrate any benefit to being on antibiotics prior to the diagnosis, irrespective of whether the ultimately-identified offending organism is sensitive or resistant.