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Original Articles
Prognostic Factors of Community-acquired Bacteremic Patients with Severe sepsis: A Prospective, Observational Study
Young Kyung Yoon1, Min Ja Kim1, Dae Won Park1, Soon Sun Kwon1, Byung Chul Chun1, Hee Jin Cheong1, Jun Yong Choi2, Hee Jung Choi3, Young Hwa Choi4, Hyo Youl Kim5, Joong Sik Eom6, Sang Il Kim7, Young Goo Song2, Kyong Ran Peck8, Yang Soo Kim9, June Myung Kim2, and Jang Wook Sohn1; Korean Sepsis Working Group
1Department of Internal Medicine, Korea University College of Medicine; 2Department of Internal Medicine, Yonsei University College of Medicine; 3Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul; 4Department of Internal Medicine, Ajou University School of Medicine, Suwon; 5Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju; 6Department of Internal Medicine, Hallym University College of Medicine, Chuncheon; 7Department of Internal Medicine, Catholic University College of Medicine; 8Department of Internal Medicine, Sungkyunkwan University School of Medicine; 9Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
Vol.44 Num.3 (p168~174)
Background: Characterization of clinical features of bacteremic severe sepsis acquired from the community has been inadequate; therefore, our goal in this study was to identify prognostic factors associated with outcome in patients with community-acquired bacteremic severe sepsis.
Materials and Methods: Adult patients (≥18 years) with community-acquired severe sepsis in whom pathogens were identified from blood cultures were included in the study. Data were collected prospectively from 12 teaching hospitals between May, 2005, and February, 2009. Data included demographic characteristics, co-morbid medical conditions, primary infection sites, sepsis severity, mortality, causative microorganisms, and the appropriateness of initial empirical antibiotic therapy.
Results: During the study period, 1,152 patients were diagnosed with communityacquired severe sepsis and 422 patients were found to harbor pathogens in their blood. Among the 422 patients analyzed, 253 (60.0%) patients went into shock and 121 patients (28.7%) died during hospitalization. Risk factors, including respiratory tract infection (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.11-6.09), number of organ dysfunctions (OR, 1.39; 95% CI, 1.13-1.71), and higher APACHE II scores (OR, 1.08; 95% CI, 1.03-1.13) showed an association with poor survival, whereas Escherichia coli as a pathogen (OR, 0.31; 95% CI, 0.16-0.64) showed an association with lower mortality.
Conclusions: In addition to severity of illness, the primary site of infection and causative microorganisms were also identified as important prognostic factors in patients with community-acquired bacteremic severe sepsis.
Keywords : Prognostic factors, Severe sepsis, Septic shock, Community-acquired infections, Bacteremia