Outcomes in severe sepsis and patients with septic shock: Pathogen species and infection sites are not associated with mortality* : Critical Care Medicine

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Clinical Investigations

Outcomes in severe sepsis and patients with septic shock: Pathogen species and infection sites are not associated with mortality*

Zahar, Jean-Ralph MD; Timsit, Jean-Francois MD, PhD; Garrouste-Orgeas, Maïté MD; Français, Adrien MG; Vesim, Aurélien MG; Descorps-Declere, Adrien MD; Dubois, Yohann MD; Souweine, Bertrand MD; Haouache, Hakim MD; Goldgran-Toledano, Dany MD; Allaouchiche, Bernard MD; Azoulay, Elie MD, PhD; Adrie, Christophe MD

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Critical Care Medicine 39(8):p 1886-1895, August 2011. | DOI: 10.1097/CCM.0b013e31821b827c



We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections.


We used a prospective observational cohort 10-yr database. We built a subdistribution hazards model with corrections for competing risks and adjustment for potential confounders including early appropriate antimicrobial therapy.


Twelve intensive care units.


We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients.



Measurements and Main Results: 

We included 1562 community-acquired, 1432 hospital-acquired, and 1012 intensive care unit-acquired episodes of severe sepsis. After adjustment, we found no independent associations of the causative organism, multidrug resistance of the causative organism, infection site, or presence of bacteremia with mortality. Early appropriate antimicrobial therapy was consistently associated with better survival in the community-acquired (0.64 [0.51–0.8], p = .0001), hospital-acquired (0.72 [0.58–0.88], p = .0011), and intensive care unit-acquired (0.79 [0.64–0.97], p = .0272) groups.


The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.


In the article on page 1886 of the August issue, an author's name was misspelled. The fifth author should have been: Aurélien Vesin.

Critical Care Medicine. 39(10):2392, October 2011.

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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