Background: Septic shock developed in 38.8% of the cases in Siriraj Hospital with a mortality rate as 52.6%. Inappropriate empiric antimicrobials is a major factor causing unfavorable mortality rate. This study aimed to assess the prevalence and impact of inappropriate antimicrobial administration on the mortality of bacteremic patients.
Methods: A retrospective cohort study of patients diagnosed as sepsis, severe sepsis, or septic shocks with positive hemoculture in the year 2009 were retrieved from the medical wards at SirirajHospital. Inappropriate antimicrobial was defined by the non-susceptibility of the isolated bacteria to the antimicrobials being used.
Results: Sepsis was diagnosed in 229 patients. Prevalence of the first-dose and 24-hour inappropriate antimicrobial were 29.7% and 25.3%, respectively. A comparison of 28-day and overall mortality rates between appropriate and inappropriate antimicrobials were 60.2% vs 67.6% (p=0.301) and 68.3% vs 75.0% (p=0.345), respectively. In septic shock patients, inappropriate antimicrobial use had higher 28-day mortality than the appropriate antimicrobial use (61.6% vs 41.9%; p=0.017). Drug-resistant organisms were the factors associated with inappropriate antimicrobial therapy(p=0.001). The golden period to start appropriate antimicrobial was less than 3 hours(p=0.03). Inappropriate first-dose antimicrobial therapy, duration of empirical therapy more than 1 hr, APACHE score >25, albumin < 3.2 g/dl and septic shock were significantly associated with mortality. The factors significantly associated with inappropriate antimicrobials were nosocomial infection, neutropenia and drug-resistant organism.
Conclusion: This study ratifies the importance of early administration of appropriate empirical antimicrobial for the septic bacteremic patients.