The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock
Bacteremia is linked to substantial morbidity and medical costs. However, the association between the timing of achieving hemodynamic stability and clinical outcomes remains undetermined. Of the multicenter cohort consisted of 888 adults with community-onset bacteremia initially complicated with sev...
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| Format: | Article |
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MDPI AG
2020-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/8/2617 |
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| author | Ching-Chi Lee Chao-Yung Yang Bo-An Su Chih-Chia Hsieh Ming-Yuan Hong Chung-Hsun Lee Wen-Chien Ko |
| author_facet | Ching-Chi Lee Chao-Yung Yang Bo-An Su Chih-Chia Hsieh Ming-Yuan Hong Chung-Hsun Lee Wen-Chien Ko |
| author_sort | Ching-Chi Lee |
| collection | DOAJ |
| description | Bacteremia is linked to substantial morbidity and medical costs. However, the association between the timing of achieving hemodynamic stability and clinical outcomes remains undetermined. Of the multicenter cohort consisted of 888 adults with community-onset bacteremia initially complicated with severe sepsis and septic shock in the emergency department (ED), a positive linear-by-linear association (<i>γ</i> = 0.839, <i>p</i> < 0.001) of the time-to-appropriate antibiotic (TtAa) and the hypotension period after appropriate antimicrobial therapy (AAT) was exhibited, and a positive trend of the hypotension period after AAT administration in the 15-day (<i>γ</i> = 0.957, <i>p</i> = 0.003) or 30-day crude (<i>γ</i> = 0.975, <i>p</i> = 0.001) mortality rate was evidenced. Moreover, for every hour delay of the TtAa, 30-day survival dropped an average of 0.8% (adjusted odds ratio [AOR], 1.008; <i>p</i> < 0.001); and each additional hour of the hypotension period following AAT initiation notably resulted in with an average 1.1% increase (AOR, 1.011; <i>p</i> < 0.001) in the 30-day crude mortality rate, after adjusting all independent determinants of 30-day mortality recognized by the multivariate regression model. Conclusively, for bacteremia patients initially experiencing severe sepsis and septic shock, prompt AAT administration might shorten the hypotension period to achieve favourable prognoses. |
| first_indexed | 2024-03-10T17:33:35Z |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T17:33:35Z |
| publishDate | 2020-08-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-60c74b0060f544348220e11829acb2ad2023-11-20T09:56:49ZengMDPI AGJournal of Clinical Medicine2077-03832020-08-0198261710.3390/jcm9082617The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic ShockChing-Chi Lee0Chao-Yung Yang1Bo-An Su2Chih-Chia Hsieh3Ming-Yuan Hong4Chung-Hsun Lee5Wen-Chien Ko6Clinical Medicine Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, TaiwanDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, TaiwanDivision of Infectious Disease, Department of Internal Medicine, Chi Mei Medical Center, Tainan 71004, TaiwanDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, TaiwanDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, TaiwanDepartment of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, TaiwanDepartment of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, TaiwanBacteremia is linked to substantial morbidity and medical costs. However, the association between the timing of achieving hemodynamic stability and clinical outcomes remains undetermined. Of the multicenter cohort consisted of 888 adults with community-onset bacteremia initially complicated with severe sepsis and septic shock in the emergency department (ED), a positive linear-by-linear association (<i>γ</i> = 0.839, <i>p</i> < 0.001) of the time-to-appropriate antibiotic (TtAa) and the hypotension period after appropriate antimicrobial therapy (AAT) was exhibited, and a positive trend of the hypotension period after AAT administration in the 15-day (<i>γ</i> = 0.957, <i>p</i> = 0.003) or 30-day crude (<i>γ</i> = 0.975, <i>p</i> = 0.001) mortality rate was evidenced. Moreover, for every hour delay of the TtAa, 30-day survival dropped an average of 0.8% (adjusted odds ratio [AOR], 1.008; <i>p</i> < 0.001); and each additional hour of the hypotension period following AAT initiation notably resulted in with an average 1.1% increase (AOR, 1.011; <i>p</i> < 0.001) in the 30-day crude mortality rate, after adjusting all independent determinants of 30-day mortality recognized by the multivariate regression model. Conclusively, for bacteremia patients initially experiencing severe sepsis and septic shock, prompt AAT administration might shorten the hypotension period to achieve favourable prognoses.https://www.mdpi.com/2077-0383/9/8/2617bacteremiaempiricalantibioticvasopressor agentssevere sepsisseptic shock |
| spellingShingle | Ching-Chi Lee Chao-Yung Yang Bo-An Su Chih-Chia Hsieh Ming-Yuan Hong Chung-Hsun Lee Wen-Chien Ko The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock Journal of Clinical Medicine bacteremia empirical antibiotic vasopressor agents severe sepsis septic shock |
| title | The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock |
| title_full | The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock |
| title_fullStr | The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock |
| title_full_unstemmed | The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock |
| title_short | The Hypotension Period after Initiation of Appropriate Antimicrobial Administration Is Crucial for Survival of Bacteremia Patients Initially Experiencing Severe Sepsis and Septic Shock |
| title_sort | hypotension period after initiation of appropriate antimicrobial administration is crucial for survival of bacteremia patients initially experiencing severe sepsis and septic shock |
| topic | bacteremia empirical antibiotic vasopressor agents severe sepsis septic shock |
| url | https://www.mdpi.com/2077-0383/9/8/2617 |
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