Sepsis is the most common cause of death in non CCU
units. The death rate has been reported
as being between 30-70% (average 50%).
Sepsis is defined as having SIRS plus a source for
infection.
SIRS (two or more of the following)
◦Temp
>38 or <36 C
◦HR
>90 beats per minute
◦RR
>20 breaths per minute (PCO2 <32)
◦WBC
>12,000 or <4,000
Severe sepsis is sepsis associated with organ dysfunction,
hypoperfusion or hypotension. Septic
shock is sepsis with hypotension despite adequate fluid resuscitation along
with the presence of perfusion abnormalities.
One of the first studies that demonstrated that early
antibiotics improved survival was an animal model that perforated the cecum in
mice to induce sepsis. Most of the
animals that received early antibiotics (0,6,12 hours) lived (90%+). Most of the mice that did not receive
antibiotics until 15 hours after the surgery died. All of the mice died that received
antibiotics 18 hours after the surgery died.
In a study performed by Kumar et al, Dr. Kumar demonstrated
a strong relationship between time of antibiotics given and survival. Dr. Kumar measured the time it took to start
antibiotics in over 2000 hypotensive patients.
He found that if antibiotics were started within 30 minutes there was an
82% survival. If the antibiotics were
withheld for 36 hours, survival dropped to 10%. In fact, there was a worsening mortality for
every hour that antibiotics were delayed (see graph).
In a separate paper in 2009, Kumar et al found that there is
a fivefold reduction of survival in patients with septic shock if the wrong
antibiotics were given.
In conclusion, early, broad-spectrum antibiotics should be
given in patients who are suspected of having septic shock.
Kumar et al. Duration
of Hypotension Before Initiation of Effective Antimicrobial Therapy is The
Critical Determinant Of Survival In Human Septic Shock. Crit Care Med 2006; 34: 1589-1596.
from Dr. John Cull
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