Prospective evaluation of septic shock patients in a tertiary care educational university hospital: a series of 1892 cases
Makaleler > Tam Makale · 2024
Yazarlar: Gamze Şanlıdağ Işbilen, Deniz Akyol Seyhan, Merve Mert Vahabi, Buse Kenanoğlu, Dilşah Başkol Elik, Seichan Ketentzi, Oğuzhan Acet, Nazlihan Yalçin, Cansu Bulut Avşar, Ayşe Öna, Arda Kaya, Şükrü Dirik, Uğur Öna, Buğra Özkar, Damla VERENDAĞ, Derya Kaya, Gunel Guliyeva, Cansu Tol, Meltem Ceylan, Gökhan VATANSEVER, Melike Demir, Serhat Uysal, Hilal Sipahi, Sabire Şöhret AYDEMİR, Meltem TAŞBAKAN, Bilgin ARDA, Oğuz Reşat Sipahi
Journal of Global Antimicrobial Resistance, Uluslararası, Wos, 2024, cilt 39, ss 52-53
DOI: 10.1016/j.jgar.2024.10.167
Özet
We aimed to evaluate the septic shock(SS) cases in terms of mortality and effecting variables for outcomes. Despite advancements and the early implementation of targeted therapies,sepsis-related mortality remains high. Patients who had SS and consulted to Infectious Diseases between December 2013-September 2023 in our center were followed-up prospectively.Arterial lactate level 2 mg/dL criterion was added as an including criteria for SS according to the latest guidelines.Statistical analysis was performed via Chi-square test, a p value<0.05 was considered significant.Neutropenic(<500/mm3) cases were excluded. There were a total of 1892 patients(mean age 66.85±15.18 years and 41.75% female).1057(55.87%) patients in non-hospital acqurieed(admitted with SS or SS developed in less than 48h)(NHASS),835(44.13%) patients in hospital SS(HASS) group fulfilled the study criteria.Mean CRP,leukocyte count,procalcitonin levels were 15.26±11.68 mg/dl,17023±15347/mm3 and 20.77±31.04 µg/l.Arterial lactate level was available in 1534 cases(mean:5.89±4.84 mg/dl). The most common infection sites were pneumonia(n:797-39%) followed by intraabdominal infection(n:428-22.6%) and urinary tract infection(UTI-n:315-16.6%).Microbiological etiology was elucidated in(n:934-49.4%)cases. The most common pathogens were 223 E.coli(%67.8 ESBL+),203 Klebsiella spp.(57.6% carbapenem-resistant),149(7.9%) yeasts and 146 Acinetobacter spp.(91.1% carbapenem-resistant).In 318(34.04%) of 934 cases,>1 pathogen were isolated.One month mortality(OMM) in overall cohort was 76.64% and significantly higher than UTI or intraabdominal infection in the pneumonia SS subgroup(Table,p=0.027).OMM was higher in HASS than in NHASS[79.04%vs.74.64%,p:024].OMM with proven etiology and others were[75.8%vs.77.34%,p:0.427].OMM was significantly higher in lactate>2 subgroup(Table,p<0.001) and in those antibiotics could be started >1 h after the start of the antibiotics(Table,p<0.014). The worst outcomes were in pneumonia subgroup.We need more efficient diagnostic as well as and therapeutic tools to decrease the significant mortality.