PURPOSE: Cohen et al recently suggested that the site of infection and responsible organism should be considered as factors contributing to mortality in patients with sepsis or septic shock. We sought to verify this approach.
METHODS: Clinical data and outcome variables were extracted from the medical records of 110 adult patients admitted to the intensive care unit at the University of Oklahoma, Health Sciences Center or the Oklahoma City VA Medical Center with severe sepsis and a microbiologically confirmed infection for whom informed consent was obtained. Patients were divided into 5 different categories based on the site of infection: 1-Bloodsteam infections; 2-Pneumonia; 3-skin and soft tissue infections; 4-UTI; 5-Intraabdominal infections. Three patients with CNS infection were excluded.
RESULTS: Death occurred in 49 patients. Mortality was associated with the infecting organism regardless of the site of infection (p:0.0014). The mortality associated with P. aeruginosa was 69%, whereas the mortalities associated with S. aureus and E. coli were 53 and 21% respectively. Bloodstream infection was associated with a 67% mortality with candidemia having the highest mortality(100%) while P. aeruginosa and S. aureus were associated with 50% and 57% mortality respectively. Among patients with abdominal infection, 4 out of 10 patients with E. coli, P. aeruginosa and Klebsiella species died, compared to all 3 patients with positive fungal cultures. Mortality was 45% among patients with pneumonia, and highest for P. aeruginosa(87%) vs S. pneumoniae(31%). Staphylococcal pneumonia was associated with 71% mortality. 6 patients(46%) died from skin and soft tissue infections, with Streptococcus and Enterococcus species having the highest mortality(60–100%). UTI had the lowest mortality(21%), and was similar for E coli and Enterococcus(14%). P. aeruginosa UTI had the highest mortality (66%).
CONCLUSION: The site of infection as well as the nature of the organisms have a significant impact on the mortality rate in sepsis.
CLINICAL IMPLICATIONS: The nature of the organisms should be taken into consideration when designing clinical trials, as it has a significant impact on outcome of patients with sepsis or septic shock.
DISCLOSURE: George Nassif, No Financial Disclosure Information; No Product/Research Disclosure Information