Table 3.
Comparison of studies investigating antibiotic treatment in patients with sepsis
| Parameter | Kumar et al . [ 4 ] Crit Care Med (2006) | Ferrer et al . [ 10] Crit Care Med (2014) | Puskarich et al . [ 11 ] Crit Care Med (2011) | Bloos et al . [ 12 ] Crit Care (2014) | Hranjec et al . [ 13 ] Lancet Infect Dis (2012) | |
|---|---|---|---|---|---|---|
| Study design | Retrospective multicenter cohort study | Retrospective analysis of prospective collected dataset multicenter | Prospective preplanned analysis of a multicenter randomized clinical trial | Prospective multicenter cohort study | Prospective quasi-experimental, before-and-after observational study single center | |
| Setting | ICU septic shock | ICU mixed | ED septic shock | ICU | ICU-acquired infection | |
| Aggressive | Conservative | |||||
| Patients | 2,731 | 17,993 | 291 | 1,011 | 247 | 237 |
| Age, years | 63 | NR | 62 (IQR 50–73) | 69 | NR | NR |
| Gender, male | 54% | NR | 53% | 63% | NR | NR |
| APACHE score | 26 ± 9 | NR | NR | NR | NR | NR |
| SAPS II | NR | NR | 42 (IQR 30–55) | 48 (IQR 37–60) | NR | NR |
| SOFA score | NR | NR | 6 (IQR 4–9) | 10 (IQR 8–12) | NR | NR |
| MEDS score | NR | NR | 11 (IQR 8–14) | NR | NR | NR |
| Septic shock | 2,731 (100%) | 11,558 (64.2%) | 291 (100%) | NR | 38.5% | 46.4% |
| Positive BC | 34.2% | NR | 100 (34.4%) | 317 (48.8%) | NR | NR |
| Nosocomial | 58.1% | 12.2% | NR | 56.2% | NR | NR |
| Median time to shock recognition | NR | NR | 89 (IQR 48–180) | NR | NR | NR |
| Overall mortality | 56.2% | 31.3% | 55 (18.9%) | 41.4% | 99 (40.1%) | 50 (21.1%) |
| Mortality for BC-positive septic shock | NR | NR | 26/100 (26.0%) | NR | NR | NR |
| Mortality for BC-negative septic shock | NR | NR | 29/191 (15.2%) | NR | NR | NR |
| Infection site | ||||||
| Pneumonia | 1,016 (37.2%) | 8,487 (47.2%) | 99 (34.0%) | 351 (34.9%) | 75 (20%) | 93 (39%) |
| UTI | 293 (10.7%) | 4,757 (26.4%) | 71 (24.4%) | 122 (12.1%) | 33 (13%) | 36 (15%) |
| Intra-abdominal | 801 (29.3%) | 3,505 (19.5%) | 49 (16.8%) | 366 (36.3%) | 31 (13%) | 22 (9%) |
| Skin and soft tissue | 197 (7.2%) | 1,133 (6.3%) | 23 (7.9%) | NR | NR | NR |
| Intravascular catheter | 100 (3.7%) | 661 (3.7%) | 11 (3.8%) | NR | 14 (6%) | 8 (3%) |
| Surgical wounds | 31 (1.1%) | 815 (4.5%) | 7 (2.4%) | NR | 19 (8%) | 21 (9%) |
| Endocarditis | NR | 187 (1.0%) | 4 (1.4%) | NR | NR | NR |
| CNSI (e.g., meningitis) | 20 (0.7%) | 277 (15%) | 3 (1.0%) | NR | NR | NR |
| Septic arthritis | 21 (0.8%) | NR | 2 (0.7%) | NR | NR | NR |
| SDI | 58 (2.1%) | NR | 1 (0.3%) | NR | NR | NR |
| Ear, nose, throat | NR | NR | 1 (0.3%) | NR | NR | NR |
| Toxic shock syndrome | NR | NR | 1 (0.3%) | NR | NR | NR |
| Unknown | 120 (4.4%) | NR | 40 (13.8%) | 50 (5%) | 49 (20%) | 46 (19%) |
| Two or more sources | NR | NR | 21 (7.2%) | NR | NR | NR |
| Mediastinitis | 15 (0.5%) | NR | NR | NR | NR | NR |
| Other | 59 (2.1%) | 1,980 (11.0%) | NR | 105 (10.4%) | 26 (11%) | 11 (5%) |
| Bone | NR | 232 (1.3%) | NR | NR | NR | NR |
| Device | NR | 219 (1.2%) | NR | NR | NR | NR |
| Bone/soft tissue | NR | NR | NR | 72 (7.1%) | NR | NR |
| Upper airway | NR | NR | NR | 83 (8.2%) | NR | NR |
APACHE, Acute Physiology and Chronic Health Evaluation; BC, blood culture; CNSI, central nervous system infection; ED, emergency department; IQR, interquartile range; MEDS, Mortality in Emergency Department Sepsis; NR, not reported; SAPS II, Simplified Acute Physiology Score II; SDI, systemically disseminated infection; SOFA, Sequential Organ Failure Assessment; UTI, urinary tract infection.