Appropriateness of Broad Spectrum Antibiotics for Severe Sepsis and Septic Shock in the Emergency Department.

OBJECTIVE: Determine the appropriateness of broad-spectrum antibiotics applied in severe sepsis and septic shock in an emergency room and its impact on the survival rate.

MATERIAL AND METHOD: This was a prospective observational study in an emergency room setting at a tertiary care facility where early goal-directed therapy (EGDT) was applied for resuscitation of severe septic and septic shock patients. The data recorded were the initial vital signs, SAP II score, time of EGDT goals achieved (ScvO₂> 70), time of antibiotics initiated, type of antibiotics used, organisms that were identified, source of infection, initial and final diagnosis, and outcome of treatment. The student's t-test and Mann Whitney U test were used to compare survival rates between appropriate and inappropriate antibiotics used.

RESULTS: Seventy-eight newly diagnosed severe septic and septic shock cases were treated per the EGDT protocol. There were 41 (52.6%) male and 37 (47.4) female patients. The organisms were identified by hemoculture in 28 cases, 18 (64.3%) cases were gram-negative, seven (25.0%) cases were gram-positive, and three (10.7%) were mixed organisms. The five most common sites of infection were 30 (38.5%) cases of lung infection, 18 (23.1%) cases of bacteremia, 16 (20.5%) of gastrointestinal tract infection, 15 (19.2%) cases were genito-urinary tract infection, and six (7.7%) were skin and soft tissue infection. The mean SAP II score was 44.2 ± 15.4 and the mean time to initiate antibiotics was 59 ± 50 minute. Fifty-five cases (70.5%) were classified as appropriate antibiotics group, 31 (56.4%) of the 55 cases survived, while only nine (39.1%) of the 23 cases in the inappropriate group survived. This was not statistically significant.

CONCLUSION: The most common sources of infection of septic patients were lung infection, bacteremia, gastrointestinal tract infection, genito-urinary tract infection, and skin and soft tissue infection. The hemocultures were positive in 58.9% of the cases and the common organisms were E. coli, K. pneumonia, S. aureus, and S. pneumoniae. The immunocompromised, multiple co-morbid and prolonged intubated patients should receive antibiotics to cover ESBL-producing E. coli, P. aeruginosa, and A. baumannii.