AT ICAAC 2015

SAN DIEGO (FRONTLINE MEDICAL NEWS) – The longer patients have sepsis, the more likely they are to die while in the hospital, a retrospective, single-center study showed.

However, lower respiratory tract infection, methicillin-resistant Staphylococcus aureus infection, Charlson score, and time to first antibiotic dose were not significantly associated with increased odds for mortality.

“Sepsis is a life-threatening acute condition that is commonly associated with inpatient mortality,” lead study author Joseph J. Carreno, Pharm.D., said in an interview in advance of the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. “To date, numerous interventions have evaluated the impact of interventions on sepsis-related mortality. However, few have examined duration of sepsis as a predictor of mortality.”

An earlier analysis conducted by Dr. Carreno and his associates at the Albany (N.Y.) College of Pharmacy and Health Sciences found that the duration of sepsis may be reduced through the use of multimodal interventions implemented by interdisciplinary teams.

For the current study, the researchers set out to evaluate the relationship between time to sepsis resolution and inpatient mortality by reviewing the records of 248 patients with documented sepsis who received antimicrobial therapy at Albany Medical Center Hospital. They defined time to sepsis resolution as time in days from blood culture to first date with fewer than two signs of systemic inflammatory response syndrome.

The mean age of the patients was 63 years, 67% were male, and 31% initially were admitted to the intensive care unit. The most prevalent sources of infection were genitourinary (24%), lower respiratory tract (17%), and endovascular (17%), while the most prevalent organisms isolated were coagulase-negative Staphylococcus (20%), Escherichia coli (18%), Streptococcus (15%), and methicillin-sensitive S. aureus (8%).

In all, 21 patients (9%) died. On multivariable analysis, the only significant risk factors for inpatient mortality were time (in days) to sepsis resolution (odds ratio, 1.13) and being initially admitted to the ICU (OR, 5.21).

“What was most surprising to me was the steady increase in mortality that was seen with each day of unresolved sepsis,” Dr. Carreno commented. “We hypothesized that there would be an association between time to sepsis resolution and mortality, but we thought that there would be a natural cut point rather than a steady increase in risk.”

Others factors such as lower respiratory tract infection, Charlson score, methicillin-resistant S. aureus infection, and time to first antibiotic dose didn’t have a significant association with increased odds for mortality.

“In our study, prolonged duration of sepsis was an early predictor of inpatient mortality,” he concluded. “Hence, patients’ response to therapy should be evaluated early in therapy. Our study supports recommendations from the Food and Drug Administration’s new guidance for clinical trials and the Centers for Disease Control and Prevention’s antibiotic ‘time out’ concept.”

Dr. Carreno reported having no financial disclosures.

dbrunk@frontlinemedcom.com

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