Patients who present to the ICU with neutropenic septic shock (NSS) are at a high risk of death. Purpose of the study was to find out the inappropriate selection of antimicrobials in patients with NSS and to study predictors of ICU outcome.
This is retrospective study of patients who were admitted to Harper Hospital ICU with diagnosis of NSS from September 2006 to June 2008. Antibiotics were considered appropriate (AA) if they covered the organism cultured within 48 hours of onset of shock or in the case of culture-negativity, meeting hospital criteria for empiric coverage (broad spectrum beta lactam or monobactam plus vancomycin). If it didn’t fulfill above criteria it was considered inappropriate antibiotics (IA).
There were 56 patients identified with mean age of patients was 57.2. 71% were males. Hematopoietic stem cell transplants made up 38%. The mean ANC was 233 at the time of sepsis. Overall mortality was 63%. Based on culture results 25% of the patients were given inappropriate antibiotics (IA); of these mortality rate was 93% while mortality for patients with appropriate antibiotics was 40%. During univariate logistic regression inappropriate antibiotic was significant factor responsible for mortality. (Odds ratio: 5.3, p = 0.04) Amongst patients who had undergone for BMT there was no significant difference for mortality compared to patients who did not go for BMT but patients who had undergone BMT > 100 days ago had higher trend toward mortality compared to patients who had undergone for BMT < 100 days. There was statistically significant difference in LOS in ICU for the patients who received appropriate antibiotics vs. who did not. (5.6 vs. 12.6 days, p = 0.014).
In neutropenic septic shock it is essential to initiate appropriate antibiotics. Failure to do so results in an unacceptably high mortality rate.
Appropriate antimicrobial selection is key point for patients with NSS. Patients of BMT with septic shock should be treated aggressively as they have trend toward higher mortality even in late phase.
Bhavinkumar Dalal, No Financial Disclosure Information; No Product/Research Disclosure Information