Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores

• Published in: European Journal of Clinical Microbiology & Infectious Diseases Vol. 40; no. 3; pp. 535 - 540
• Main Authors: Yoshida, Junichi, Tamura, Tetsuro, Otani, Kazuhiro, Inoue, Masaaki, Miyatake, Eiji, Ishimitsu, Toshiyuki, Nakahara, Chihiro, Tanaka, Masao
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Science and Business Media LLC 01.03.2021; Springer Berlin Heidelberg; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Antiinfectives and antibacterials; Antimicrobial agents; Biomedical and Life Sciences; Biomedicine; Confidence intervals; Diagnosis; Drug resistance; Drug Resistance, Bacterial; Female; Hospital Mortality; Humans; Internal Medicine; Male; Medical Microbiology; Methicillin; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mortality; Mortality risk; Observational studies; Organ Dysfunction Scores; Original; Original Article; Patients; Prognosis; Public health; Regression analysis; Retrospective Studies; Risk Factors; Sepsis; Staphylococcus aureus; Staphylococcus infections; Statistical analysis; Surgery; Surgery Department, Hospital; Thoracic surgery; β Lactamase; Sequential organ failure assessment score; Methicillin-resistant; Sepsis; Methicillin-resistant Staphylococcus aureus
• ISSN: 0934-9723; 1435-4373; 1435-4373
• DOI: 10.1007/s10096-020-04037-w

The difference in sequential organ failure assessment (SOFA) scores from the baseline to sepsis is a known predictor of sepsis-3 outcome, but the prognostic value of drug-resistant organisms for mortality is unexplained. We employed sepsis stewardship and herein report an observational study. Study subjects were patients admitted to the Departments of Surgery/Chest Surgery from 2011 through 2018 with a diagnosis of sepsis and a SOFA score of 2 or more. Our sepsis stewardship methods included antimicrobial and diagnostic stewardship and infection control. We determined the primary endpoint as in-hospital death and the secondary endpoint as the annual trend of the risk-adjusted mortality ratio (RAMR). For mortality, we performed logistic regression analysis based on SOFA score, age, sex, comorbid disease, and the presence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase inhibitor–producing bacteria. In a total of 457 patients, two factors were significant predictors for fatality, i.e., SOFA score of 9 or more with an odds ratio (OR) 4.921 and 95% confidence interval [95% CI] 1.968–12.302 ( P = 0.001) and presence of MRSA with an OR 1.83 and 95% CI 1.003–3.338 ( P = 0.049). RAMR showed a decrease during the study years ( P < 0.05). Early detection of MRSA may help patients survive surgical sepsis-3. Thus, MRSA-oriented diagnosis may play a role in expediting treatment with anti-MRSA antimicrobials.