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Delayed and inappropriate antimicrobial therapy increases mortality in cirrhosis

This month's issue of Hepatology identifies antimicrobial therapeutic determinants of septic shock in cirrhosis.

News image

It is unclear whether practice-related aspects of antimicrobial therapy contribute to the high mortality from septic shock among patients with cirrhosis.

Dr Yaseen Arabi and colleagues from Saudi Arabia examined the relationship between aspects of initial empiric antimicrobial therapy and mortality in patients with cirrhosis and septic shock.

The team performed a nested cohort study within a large retrospective database of septic shock from 28 medical centers in Canada, the United States, and Saudi Arabia by the Cooperative Antimicrobial Therapy of Septic Shock Database Research Group between 1996 and 2008.

The team examined the impact of initial empiric antimicrobial therapeutic variables on the hospital mortality of patients with cirrhosis and septic shock.

Hospital mortality was 76%
Hepatology

Among 635 patients with cirrhosis and septic shock, the hospital mortality was 76%.

Inappropriate initial empiric antimicrobial therapy was administered in 24% of patients.

The median time to appropriate antimicrobial administration was 7 hours.

The use of inappropriate initial antimicrobials was associated with increased mortality, as was the delay in appropriate antimicrobials.

The research team found that among patients with eligible bacterial septic shock, a single rather than 2 or more appropriate antimicrobials was used in 73% of patients, and was also associated with higher mortality.

The team observed that these findings were consistent across various clinically relevant subgroups.
 
Dr Arabi's team concludes, "In patients with cirrhosis and septic shock, inappropriate and delayed appropriate initial empiric antimicrobial therapy is associated with increased mortality."

"Monotherapy of bacterial septic shock is also associated with increased mortality."

Hepatology 2012: 56(6): 2305–2315
24 December 2012

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