Prognostic factors of community-acquired bacteremic patients with severe sepsis: A prospective, observational study

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.