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

Crit Care Med. 2011 Aug;39(8):1886-95. doi: 10.1097/CCM.0b013e31821b827c.


Objectives: 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.

Design: 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.

Setting: Twelve intensive care units.

Patients: We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None.

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.

Conclusion: 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.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Cause of Death*
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / microbiology
  • Community-Acquired Infections / mortality
  • Critical Care
  • Cross Infection / drug therapy
  • Cross Infection / microbiology
  • Cross Infection / mortality
  • Databases, Factual
  • Drug Resistance, Microbial*
  • Female
  • Gram-Negative Bacteria / drug effects
  • Gram-Negative Bacteria / pathogenicity
  • Gram-Positive Bacteria / drug effects
  • Gram-Positive Bacteria / pathogenicity
  • Hospital Mortality / trends
  • Humans
  • Intensive Care Units
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Sepsis / drug therapy*
  • Sepsis / microbiology
  • Sepsis / mortality*
  • Severity of Illness Index
  • Shock, Septic / drug therapy*
  • Shock, Septic / microbiology
  • Shock, Septic / mortality
  • Survival Rate
  • Treatment Outcome


  • Anti-Bacterial Agents