Prospective evaluation of septic shock patients in a tertiary care educational university hospital: a series of 527 cases


Creative Commons License

Önal U., Akyol D., Uyan A., Bulut C., Akdağ D., Guliyeva G., ...More

29.ECCMID , Amsterdam, Netherlands, 13 - 16 April 2019, pp.2398-2399

  • Publication Type: Conference Paper / Summary Text
  • City: Amsterdam
  • Country: Netherlands
  • Page Numbers: pp.2398-2399

Abstract

Background: In this study it was aimed to evaluatetheseptic shock (SS) cases in terms of mortality and effecting variables for outcomes in a tertiary-careeducational university hospital. Materials/methods: Patients who had SS (sepsis+hypotension+adrenergicagent) and consulted by Infectious Diseases consultants between Dec 2013 and Sep 2018 in our center werefollowed up prospectively. Arterial lactatelevel of >2 mg/dL criterion was added as an including criteria for SS according to 3rd International Sepsis and SepticShock Consensus Statementafter 23rd Feb 2016.Statistical analysis was performed via Chi squaretest and a p value < 0.05 was considered significant. Results:There werea total of 527 patients (mean age 65.94 ± 0.67 years and 43.8% female). Mean CRP, leukocyte countand procalcitonin levels were 17.49 ± 0.53 mg/dl, 16435 ± 723/mm3 and 23.63 ± 2.37 µg/L respectively. Arterial lactatelevel was availablein 427 cases (mean:5.06 ± 0.20 mg/dL).The most common sites of infection wererecorded as pneumonia (n:282) followed by intraabdominal infection (n:132) and urinary tract infection (n:117). Microbiological etiology was elucidated in 251 cases.The most common pathogens were 65 E.coli (43 ESBL+), 53 Klebsiella spp. (33 carbapenem-resistant), 37 yeasts and 31 Acinetobacter spp. In 71 out of 251 cases, >1 pathogen wereisolated. Median values of thescoresystems were 11 for SOFA, 2 for qSOFA and 3 for SIRS, respectively. Among 136 patients qSOFA score was equal to three points and 30 day mortality rate was significantly higher (102/136 vs 235/391, p=0.001) among them. One month mortality was 63.9% (337/527) and significantly higher (95/132 vs 233/382, p=0.024) in theintraabdominal infection SS subgroup. In terms of mortality at one month,carbapenem+glycopeptidetreatmentversus other antibiotic regimens had no statistical difference(174/288 vs 101/152, p=0,214) but it was higher in colistin including versus non including regimens (53/67 vs 228/385, p=0.001). Conclusions:SS patients have different properties in terms of infection sourceand it seems to be possiblethat qSOFA score >2 for sepsis screening seems to definethecases associated with poor outcome. Colistin empirical treatment should beanalysed in further studies.