Examining the effect on mortality of time elapsed between diagnosing the patients with severe sepsis, diagnosed with septic shock in internal medicine intensive care service and starting antibiotherapy respectively

Examining the effect on mortality of time elapsed between diagnosing the patients with severe sepsis, diagnosed with septic shock in internal medicine intensive care service and starting antibiotherapy respectively. Dr. Yakup Duran Dokuz Eylül University Faculty of Medicine Department of Internal Medicine İnciraltı/ İZMİR duran.yakup@hotmail.com AİM: Sepsis is an infection and a response to infection, which maintains its importance in spite of the improvements in treatment methods. Despite there have been advances in treatment methods, mortality is very high even in the most advanced centers especially if there is a septic shock template including organ failure. The most important step in sepsis treatment is necessity of beginning the effective and broad spectrum antimicrobial systematically. In this study, we aimed to investigate the effect on mortality of time elapsed between diagnosing the patients with severe sepsis, diagnosed with septic shock in Internal Medicine Intensive Care Service and starting antibiotherapy. METHOD: The records of treated patients in internal medicine intensive care service between January 2010 and June 2014 were examined retrospectively. The patients over 18 years who are diagnosed with severe sepsis and septic shock and the patients with non-metastatic malignancy in advanced stage were included in the study. The file, laboratory tests and scans of the 110 patients whose records could be reached were investigated retrospectively. RESULTS: 61 of the 110 patients were male and others (49) were female. It was determined that while the time of the antibiotic intake of 90 patients was early, the time of antibiotic intake of 20 patients was late. Average ages of the patients with late and early antibiotic intake were calculated as 73,9±12,2 and 76±8,6 respectively. The difference was not statistically significant (p>0,05). When evaluated in terms of disease severity, the average APACHE II score of the group whose antibiotic intake was early was determined as 18,2±7,5, and other group's ( late antibiotic intake) was 19,4±7,4. Difference between scores was not statistically significant (p>0,05). With regard to co-morbidities, no significant difference was determined between two groups. Being late of the time of the antibiotic intake in logistic regression model in which age, sex, APACHE II score and other co-morbidities included, very high APACHE II score and determination of culture positivity were evaluated as an independent risk factor for increased mortality. CONCLUSİON: As soon as possible severe sepsis and septic shock are diagnosed; the intravenous antibiotic treatment should be started in the first hour according to international guidelines. In our study, being three hours late of the time of antibiotic intake was determined as an independent risk factor for increased mortality. While the mortality was %25 in the patients taking the antibiotic early, this rate was % 61 in the patients taking the antibiotic late. In the logistic regression analysis to determine the other factors affecting the mortality, APACHE II Score and culture positivity were determined as other independent risk factors.