SEPTIC SHOCK IN BACTEREMIC PATIENTS - RISK-FACTORS, FEATURES AND PROGNOSIS

Of 4,289 episodes of bacteremia detected in 3,631 patients, septic sho ck was diagnosed in 453 episodes (10.5%). In 56% of shock episodes, se ptic shock developed more than 24 h after the first positive blood cul ture was taken. In a logistic regression analysis, variables predictiv e of septic shock were: advanced age [odds ratio (OR) of 1.015 for an increment of 1 year]; renal failure as an underlying disorder (OR = 1. 47); neutropenia (OR of 2.26); curtailed functional capacity (OR of 1. 54 for an increment of 1 category); unknown source of infection (OR = 1.66); anaerobic (OR = 2.86), polymicrobial bacteremia (OR = 1.54), or pathogens other than Streptococcus viridans (OR = 0.08 for Streptococ cus viridans). The in-hospital mortality associated with septic shock was 80% vs 21% in episodes of bacteremia without shock, and shock epis odes accounted for 31% of all deaths. The fatality rate in shock patie nts given appropriate empiric antibiotic treatment was 74.9% vs 84.7% in patients given inappropriate treatment (p = 0.01). Judging by the p resent results, host factors are more important determinants for devel opment of septic shock in bacteremic patients than the type of pathoge n. Even in patients with shock, appropriate empiric antibiotic treatme nt was associated with an improved chance of survival.