Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock

Artero, Arturo; Zaragoza, Rafael; Camarena, Juan J.; Sancho, Susana; González, Rosa; Nogueira, José M.

doi:10.1016/j.jcrc.2009.12.004

« Previous Next »Journal of Critical Care
Volume 25, Issue 2 , Pages 276-281, June 2010

Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock☆☆☆

Arturo Artero, MD,PhD
- Department of Internal Medicine, Hospital Universitario Dr Peset Av Gaspar Aguilar 90, 46017 Valencia, Spain
- Corresponding author. Tel.: +34 961622457; fax: +34 961622301.
Rafael Zaragoza, MD
- Intensive Care Unit, Hospital Universitario Dr Peset Valencia, 46017 Valencia, Spain
Juan J. Camarena, MD,PhD
- Department of Microbiology, Hospital Universitario Dr Peset Valencia, 46017 Valencia, Spain
Susana Sancho, MD,PhD
- Intensive Care Unit, Hospital Universitario Dr Peset Valencia, 46017 Valencia, Spain
Rosa González
- Department of Microbiology, Hospital Universitario Dr Peset Valencia, 46017 Valencia, Spain
José M. Nogueira, MD,PhD
- Department of Microbiology, Hospital Universitario Dr Peset Valencia, 46017 Valencia, Spain

published online 11 February 2010.

Abstract

Purpose

The purpose of the study was to determine the independent risk factors on mortality in patients with community-acquired severe sepsis and septic shock.

Methods

A single-site prospective cohort study was carried out in a medical-surgical intensive care unit in an academic tertiary care center. One hundred twelve patients with community-acquired bloodstream infection with severe sepsis and septic shock were identified. Clinical, microbiologic, and laboratory parameters were compared between hospital survivors and hospital deaths.

Results

One-hundred twelve patients were included. The global mortality rate was 41.9%, 44.5% in septic shock and 34.4% in severe sepsis. One or more comorbidities were present in 66% of patients. The most commonly identified bloodstream pathogens were Escherichia coli (25%) and Staphylococcus aureus (21.4%). The proportion of patients receiving inadequate antimicrobial treatment was 8.9%. By univariate analysis, age, Acute Physiology and Chronic Health Evaluation II score, at least 3 organ dysfunctions, and albumin, but neither microbiologic characteristics nor site of infection, differed significantly between survivors and nonsurvivors. Acute Physiology and Chronic Health Evaluation II (odds ratio, 1.13; 95% confidence interval, 1.06-1.21) and albumin (odds ratio, 0.34; 95% confidence interval, 0.15-0.76) were independent risk factors associated with global mortality in logistic regression analysis.

Conclusion

In addition to the severity of illness, hypoalbuminemia was identified as the most important prognostic factor in community-acquired bloodstream infection with severe sepsis and septic shock.

Keywords: Bacteremia, Sepsis syndrome, Septic shock, Intensive care unit, Mortality, Inadequate empirical antimicrobial treatment