Sepsis syndrome (SS) is a clinical syndrome that develops when an infection triggers a dysregulated inflammatory host response, resulting in life-threatening organ dysfunction (1). It exists on a continuum of severity, ranging from early infection and bacteraemia to severe sepsis and septic shock (1). Sepsis can ultimately result in multiple organ failure and death, and is a major cause of morbidity and mortality globally.
Sepsis has a high mortality rate. In excess of 3000 Australians die of sepsis annually – a rate higher than the annual national road toll (3). In one study, the mortality associated with sepsis was over 10%, whilst mortality from septic shock surpassed 40% (2). Whatsmore, for each hour of delay in antibiotic treatment there …show more content…
The researchers found no significant mortality benefit of administering antibiotics within 3 hours of ED triage or 1 hour of shock recognition for patients with severe sepsis and septic shock (6). A 2015 …..(level…evidence) similarly found that mortality amongst septic shock patients did not increase with hourly delays in administration of empiric antimicrobials (9).
These incongruous results call into question the strength of the association between hourly delays in antimicrobial treatment and mortality in septic shock patients. However, these studies do not differentiate between gram (+) and gram (-) sepsis and their differing virulence factors. It is possible that the offending microbe causing the sepsis may contribute to increased mortality and disease outcomes.
Interestingly, a 2011 retrospective cohort study (level 3 evidence) found that prior antibiotic therapy in gram(-) severe sepsis was associated with increased mortality for this patient population (8). It is plausible that patients who have received recent antibiotic therapy prior to developing sepsis would have higher rates of antibiotic resistance, so the empiric antibiotics typically chosen would have decreased efficacy or be less suitable in this patient population, contributing to increased mortality.
(clinically
Sepsis has a high mortality rate. In excess of 3000 Australians die of sepsis annually – a rate higher than the annual national road toll (3). In one study, the mortality associated with sepsis was over 10%, whilst mortality from septic shock surpassed 40% (2). Whatsmore, for each hour of delay in antibiotic treatment there …show more content…
The researchers found no significant mortality benefit of administering antibiotics within 3 hours of ED triage or 1 hour of shock recognition for patients with severe sepsis and septic shock (6). A 2015 …..(level…evidence) similarly found that mortality amongst septic shock patients did not increase with hourly delays in administration of empiric antimicrobials (9).
These incongruous results call into question the strength of the association between hourly delays in antimicrobial treatment and mortality in septic shock patients. However, these studies do not differentiate between gram (+) and gram (-) sepsis and their differing virulence factors. It is possible that the offending microbe causing the sepsis may contribute to increased mortality and disease outcomes.
Interestingly, a 2011 retrospective cohort study (level 3 evidence) found that prior antibiotic therapy in gram(-) severe sepsis was associated with increased mortality for this patient population (8). It is plausible that patients who have received recent antibiotic therapy prior to developing sepsis would have higher rates of antibiotic resistance, so the empiric antibiotics typically chosen would have decreased efficacy or be less suitable in this patient population, contributing to increased mortality.
(clinically