• Jean-Ralph Zahar, Jean-Francois Timsit, Maïté Garrouste-Orgeas, Adrien Français, Aurélien Vesin, Aurélien Vesim, Adrien Descorps-Declere, Yohann Dubois, Bertrand Souweine, Hakim Haouache, Dany Goldgran-Toledano, Bernard Allaouchiche, Elie Azoulay, and Christophe Adrie.
• Infection Control Unit, Necker University Hospital Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.
• Crit. Care Med. 2011 Aug 1;39(8):1886-95.

ObjectivesWe 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.DesignWe 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.SettingTwelve intensive care units.PatientsWe included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None.Measurements And Main ResultsWe 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.ConclusionThe 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.

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