Impact of Initial Appropriate Antibiotics on the Outcomes of Patients with Community-Acquired and Non-Community-Acquired Sepsis in Intensive Care Units

Introduction: This retrospective study was conducted to investigate the impact of initial antimicrobial therapy on the survival of patients with culture-positive community-acquired and non-community-acquired (healthcare-associated and hospital-acquired) sepsis. Methods: All patients admitted to the intensive care unit (ICU) of Taipei Tzu Chi Hospital throughout 2014 who had culture-positive sepsis were retrospectively identified. The administration of antibiotics to which the recovered pathogens were susceptible was considered appropriate. The impact of initial appropriate antimicrobial therapy and other risk factors on the survival of patients with sepsis was assessed in univariate and multivariate Cox regression analyses. Results: Patients with non-community-acquired sepsis had more comorbidities, significantly longer length of stay in the ICU, and greater 28-day ICU mortality and 90- day mortality (p≤0.002). While a greater proportion of subjects with community-acquired sepsis received initial appropriate antibiotics before admission to the ICU (p≤0.015), initial appropriate antibiotic administration was significantly associated with improved survival only in patients with non-community-acquired sepsis (p=0.010), and not in those with community-acquired sepsis. Multivariate analysis showed that the risk of death increased with increasing Acute Physiology and Chronic Health Evaluation II (APACHE II) scores in both patients with community-acquired sepsis (HR=1.14, p=0.008) and those with non-community-acquired sepsis, (HR=1.18, p=0.014). Conclusions: Thus, appropriate empirical antimicrobial therapy is particularly important for lowering the risk of mortality of patients with non-community-acquired sepsis.