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Influence of antimicrobial treatment on mortality in septicemia
G Behrendt1, S Schneider, H R Brodt
1Department of Medicine, Universitätsklinikum, Frankfurt am Main, Germany.
Objective:
To determine the influence of antimicrobial therapy and of predisposing illness on the septicemia mortality rate.
Method:
All blood-culture-positive episodes of septicemia in the Department of Medicine at the University Hospital in Frankfurt between 1989 and 1993 were entered on a database. Underlying illnesses were classified as immunocompromising diseases (hematological malignancies, AIDS and others), severe chronic and chronic illnesses and no predisposing illnesses. Therapy was judged on the basis of the in-vitro-susceptibility of the organism ('appropriate') and the interval (no. of days) between the onset of septicemia and start of appropriate treatment noted. For mortality all deaths within 28 days after the onset of septicemia were counted.
Results:
Overall mortality due to septicemia was 18.1%, ranging from 9.4% (organ transplantation) to 50% (liver cirrhosis) according to the underlying illness. Mortality in patients receiving appropriate treatment (83.1%) was 16% as opposed to 28%, if no appropriate treatment was given (p<0.001). Comparison of appropriate treatment started within and after 48 hours revealed a reduction in mortality from 30.9% to 15.4% for early appropriate therapy in patients with hematological malignancies (p<0.002). For septicemia in patients with AIDS and chronic illnesses mortality was significantly higher (p<0.05) if treatment remained inappropriate (AIDS 28.6%, chronic illness 33.3%), but was similar when early and delayed appropriate therapy were compared (AIDS: 13% vs. 12.8%, chronic illness 11.8% vs. 11.1%).
Conclusion:
First-line treatment regimens for septicemia in patients with hematological malignancies should include the greatest possible part of the spectrum of causative organisms. In contrast to that it may be acceptable to rely to some extent on a change of treatment, when treating septicemia in patients with chronic illnesses or AIDS. These considerations are of value in the debate on rising health care costs. Several other facts, such as the stable mortality rate of 8 - 12% in previously healthy patients and the range of mortality from 9.4 - 50%, if predisposing illnesses are present, indicate the existence of adverse factors influencing the outcome of septicemia in spite of appropriate therapy. These pathophysiological factors will have to be studied in detail in order to improve the prognosis of septicemia further.
Insights
Appropriate antimicrobial therapy significantly reduces septicemia mortality. Early treatment is crucial, especially for patients with hematological malignancies, while those with chronic illnesses or AIDS may tolerate delayed appropriate treatment.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Pharmacology
Background:
- Septicemia poses a significant mortality risk, influenced by patient comorbidities and treatment timeliness.
- Understanding the interplay between predisposing conditions and antimicrobial therapy is vital for improving septicemia outcomes.
Purpose of the Study:
- To evaluate the impact of antimicrobial therapy and predisposing illnesses on septicemia-related mortality.
- To identify patient groups that benefit most from early and appropriate treatment.
Main Methods:
- Retrospective analysis of blood-culture-positive septicemia cases (1989-1993) at University Hospital, Frankfurt.
- Classification of underlying illnesses (immunocompromising, chronic, none) and assessment of antimicrobial therapy appropriateness and timing.
- Mortality defined as death within 28 days of septicemia onset.
Main Results:
- Overall septicemia mortality was 18.1%, with rates varying widely based on underlying illness (9.4% to 50%).
- Appropriate treatment reduced mortality from 28% to 16% (p<0.001).
- Early appropriate therapy (<48 hours) significantly decreased mortality in hematological malignancies (30.9% to 15.4%, p<0.002).
Conclusions:
- Treatment strategies for septicemia should be tailored to patient conditions, prioritizing broad-spectrum agents for hematological malignancies.
- For patients with AIDS or chronic illnesses, treatment adjustments may be acceptable, but early appropriate therapy remains beneficial.
- Further research into pathophysiological factors is needed to improve septicemia prognosis, especially in patients with predisposing conditions.