ArticleCritical care (London, England)2012
Antibiotic prescription patterns in the empiric therapy of severe sepsis: combination of antimicrobials with different mechanisms of action reduces mortality.
Article in Critical care (London, England), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 81 citations in OpenAlex.
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Article
- β-Lactam concentrations monitored in the early phase of community-acquired sepsis in the intensive care unit.The Journal of antimicrobial chemotherapy · 2026Observational
- Healthcare resource utilization and costs associated with inadequate initial antibiotic treatment of bacteraemia produced by carbapenem-resistant Gram-negative bacilli (CRGNB): a descriptive, observational study in Spanish hospitals.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2025Observational
- Practical Lessons on Antimicrobial Therapy for Critically Ill Patients.Antibiotics (Basel, Switzerland) · 2024Review
- Mutational Switch-Backs Can Accelerate Evolution ofFrontiers in microbiology · 2022Article
- Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study.Antibiotics (Basel, Switzerland) · 2021Article
- A ComparativeIndian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2020Article
- An approach to antibiotic treatment in patients with sepsis.Journal of thoracic disease · 2020Review
- Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit.BMC health services research · 2019Article
- Bacterial sepsis : Diagnostics and calculated antibiotic therapy.Der Anaesthesist · 2019Review
- Surviving sepsis campaign: research priorities for sepsis and septic shock.Intensive care medicine · 2018Article
- Infectious Diseases Society of America (IDSA) POSITION STATEMENT: Why IDSA Did Not Endorse the Surviving Sepsis Campaign Guidelines.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2018Article
- [Bacterial sepsis : Diagnostics and calculated antibiotic therapy].Der Anaesthesist · 2017Review
- Infusion-Compatible Antibiotic Formulations for Rapid Administration to Improve Outcomes in Cancer Outpatients With Severe Sepsis and Septic Shock: The Sepsis STAT Pack.Journal of the National Comprehensive Cancer Network : JNCCN · 2017Article
- In Vitro-In Vivo Discordance with Humanized Piperacillin-Tazobactam Exposures against Piperacillin-Tazobactam-Resistant/Pan-β-Lactam-Susceptible Escherichia coli.Antimicrobial agents and chemotherapy · 2016Article
- Bloodstream infections in the Intensive Care Unit.Virulence · 2016Review
- A Combination Strategy of Ceftriaxone, Sulbactam and Disodium Edetate for the Treatment of Multi-Drug Resistant (MDR) Septicaemia: A Retrospective, Observational Study in Indian Tertiary Care Hospital.Journal of clinical and diagnostic research : JCDR · 2015Article
- Empiric antimicrobial therapy in severe sepsis and septic shock: optimizing pathogen clearance.Current infectious disease reports · 2015Article
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Authors and funding
11 authors at 7 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAlthough early institution of adequate antimicrobial therapy is lifesaving in sepsis patients, optimal antimicrobial strategy has not been established. Moreover, the benefit of combination therapy over monotherapy remains to be determined. Our aims are to describe patterns of empiric antimicrobial therapy in severe sepsis, assessing the impact of combination therapy, including antimicrobials with different mechanisms of action, on mortality.
methodsThis is a Spanish national multicenter study, analyzing all patients admitted to ICUs who received antibiotics within the first 6 hours of diagnosis of severe sepsis or septic shock. Antibiotic-prescription patterns in community-acquired infections and nosocomial infections were analyzed separately and compared. We compared the impact on mortality of empiric antibiotic treatment, including antibiotics with different mechanisms of action, termed different-class combination therapy (DCCT), with that of monotherapy and any other combination therapy possibilities (non-DCCT).
resultsWe included 1,372 patients, 1,022 (74.5%) of whom had community-acquired sepsis and 350 (25.5%) of whom had nosocomial sepsis. The most frequently prescribed antibiotic agents were β-lactams (902, 65.7%) and carbapenems (345, 25.1%). DCCT was administered to 388 patients (28.3%), whereas non-DCCT was administered to 984 (71.7%). The mortality rate was significantly lower in patients administered DCCTs than in those who were administered non-DCCTs (34% versus 40%; P = 0.042). The variables independently associated with mortality were age, male sex, APACHE II score, and community origin of the infection. DCCT was a protective factor against in-hospital mortality (odds ratio (OR), 0.699; 95% confidence interval (CI), 0.522 to 0.936; P = 0.016), as was urologic focus of infection (OR, 0.241; 95% CI, 0.102 to 0.569; P = 0.001).
conclusionsβ-Lactams, including carbapenems, are the most frequently prescribed antibiotics in empiric therapy in patients with severe sepsis and septic shock. Administering a combination of antimicrobials with different mechanisms of action is associated with decreased mortality.
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