Date of Award
Appropriate empiric antimicrobial selection is crucial to the survival of septic shock patients. It is suspected that the use of inadequate empiric therapy occurs commonly in practice. The primary objective of this study was to determine if there is a difference in intensive care unit (ICU) length of stay (LOS) among septic shock patients with pneumonia who received adequate versus inadequate empiric antimicrobials. Adequate was defined as a lack of exposure to the same antimicrobial class and absence of previous cultures reporting resistance to the antimicrobial in the last 90 days. This was a retrospective cohort study of adult patients who were diagnosed with septic shock and pneumonia, received IV antimicrobials, and admitted to an ICU at St. Francis Indianapolis between March 1, 2011 and September 30, 2015. Forty-four patients were identified to be included in the study after screening. Of these patients, 13 patients (29.5%) received adequate therapy and 31 patients (70.5%) received inadequate therapy. ICU LOS was found to have a median of 8.5 days (IQR=7) in adequate group and 7 days (IQR=10) in the inadequate group (p=0.776). This study showed that inadequate antimicrobial therapy occurred commonly in this patient sample. A larger sample size is needed to determine the true consequences of inadequate antimicrobial therapy in the septic shock patient population. Enhancements in real time electronic alerts within the electronic medical record may be a method that can be utilized to ensure appropriate empiric antimicrobials are initiated in septic shock patients.
Stagge, Nicole, "Empiric Antimicrobial Therapy in Patients with Healthcare-Associated, Hospital-Acquired, or Ventilator-Associated Pneumonia in Septic Shock: Does Antimicrobial Reuse Influence Outcomes?" (2017). Undergraduate Honors Thesis Collection. 406.