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Published on: August 30, 2018
Influence of antibiotic therapy with hemodynamic optimization on 30-day mortality among septic shock patients cared
Romain Jouffroy1, Matthieu Holub2, Basile Gilbert3
1Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne Billancourt, France; Centre de recherche en Epidémiologie et Santé des Populations, U1018 INSERM, Paris Saclay University, France; EA 7329 - Institut de Recherche Médicale et d'Épidémiologie du Sport - Institut National du Sport, de l'Expertise et de la Performance, Paris, France.
Insights
Early prehospital antibiotic therapy (ABT) and maintaining mean blood pressure (MAP) ≥ 65 mmHg significantly reduce 30-day mortality in septic shock patients. Prompt intervention within the first hour is crucial for improving survival rates.
Area of Science:
- Emergency Medicine
- Critical Care
- Infectious Diseases
Background:
- International guidelines advocate for early intervention in septic shock, including antibiotic therapy (ABT) and hemodynamic optimization within one hour.
- This study investigates the impact of prehospital ABT and mean blood pressure (MAP) on 30-day mortality in septic shock patients.
Purpose of the Study:
- To evaluate the association between prehospital ABT administered within the first hour and MAP ≥ 65 mmHg at the end of prehospital care.
- To determine the effect of these interventions on 30-day mortality in septic shock patients.
Main Methods:
- Retrospective analysis of 530 septic shock patients requiring pre-hospital Mobile Intensive Care Unit (MICU) intervention from May 2016 to December 2021.
- Utilized Inverse Probability Treatment Weighting (IPTW) propensity score method to assess the relationship between interventions and 30-day mortality.
Main Results:
- 25% of patients received prehospital ABT; 31% had 30-day mortality.
- Prehospital ABT within the first hour was associated with significantly reduced 30-day mortality (RRa=0.14).
- Achieving MAP ≥ 65 mmHg with prehospital ABT further decreased mortality (RRa=0.08), while ABT with MAP < 65 mmHg showed less benefit (RRa=0.75).
Conclusions:
- Prehospital antibiotic therapy within the first hour and achieving MAP ≥ 65 mmHg are linked to decreased 30-day mortality in septic shock.
- These findings highlight the importance of timely interventions in prehospital settings for septic shock management.
- Further prospective studies are recommended to validate these preliminary results.
Background:
In order to reduce septic shock mortality, international guidelines recommend early treatment implementation, antibiotic therapy (ABT) and hemodynamic optimisation, within 1-h. This retrospective multicentric study aims to investigate the relationship between prehospital ABT delivered within 1st hour and mean blood pressure (MAP) ≥ 65 mmHg at the end of the prehospital stage, and 30-day mortality among patients with septic shock.
Methods:
From May 2016 to December 2021, patients with septic shock requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were retrospectively analysed. To assess the relationship between 30-day mortality and prehospital ABT delivered within 1st hour and/or MAP ≥ 65 mmHg at the end of the prehospital stage, Inverse Probability Treatment Weighting (IPTW) propensity score method was performed.
Results:
Among the 530 patients included, 341 were male gender (64%) with a mean age of 69 ± 15 years. One-hundred and thirty-two patients (25%) patients received prehospital ABT, among which 98 patients (74%) were treated with 3rd generation cephalosporin. Suspected pulmonary, urinary and digestive infections were the cause of sepsis in respectively 43%, 25% and 17%. The 30-day overall mortality was 31%. A significant association was observed between 30-day mortality rate and (i) ABT administration within the first hour: RRa = 0.14 [0.04-0.55], (ii) ABT administration within the first hour associated with a MAP ≥ 65 mmHg: RRa = 0.08 [0.02-0.37] and (iii) ABT administration within the first hour in the prehospital setting associated with a MAP < 65 mmHg at the end of the prehospital stage: RRa = 0.75 [0.45-0.85]. Patients who received prehospital ABT after the first hour have also a 30-day mortality rate decrease: RRa = 0.87 [0.57-0.99], whereas patients who did not received ABT had an increased 30-day mortality rate: RRa = 2.36 [1.89-2.95].
Conclusion:
In this study, we showed that pre-hospital ABT within the first hour and MAP≥65 mmHg at the end of prehospital stage are both associated with 30-day mortality decrease among patients suffering from septic shock cared for by a MICU. Further prospective studies are needed to confirm these preliminary results.
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