Appropriate Antibiotics and Mortality from Bloodstream Infections

Appropriate Antibiotics and Mortality from Bloodstream Infections

Streptococcal Myositis - Clindamycin

Streptococcal Toxic Shock: Clindamycin vs. -lactams

• Deep Superficial

• Cell wall inhibitors 1/7 (14 %) 12/25 (48%)

• Protein synthesis 10/12 (83%)* 10/12 (83%)*

• inhibitors (87% clindamycin)

• Zimbelman J. Pediatr Infect Dis 1999;18:1096.

The Role of Protein C in Sepsis

PROWESS Study of Protein C in Sepsis

Activated Protein C (Drotregcogin alfa, Xigris) vs. Placebo for Severe Sepsis

• 28 day all cause 24.7% 30.8%

• mortality

• Relative risk reduction 19.4 % (6.6% - 30.5%)

• Serious bleeding (#fatal) 3.5% (2) 2.0% (1) [p=.06]

• Intracranial 0.2% 0.1%

Activated Protein C for Severe Sepsis: FDA Approved Indication

• Suspected or documented infection

• Sepsis criteria

• Sepsis-induced organ dysfunction

• (i.e., shock, ARDS, ARF, DIC, acidosis)

• APACHE II >25 (31% vs. 44% 28-day mortality)

• (T, MAP, RR, PaO2, Na, K, Cr, Hct, WBC, GCS plus

• age and chronic health points)

Activated Protein C (Drotregcogin alfa, Xigris) - Long-Term Survival

• Median survival 1113 846

• (days)

• Persons > 60 years 252 130

• APACHE II > 25 450 71

Dexamethasone for Bacterial Meningitis in Adults

• Mortality (%) all pts 7 15(53%,p=0.04)

• S. pneumoniae (%) 14 34(58%p=.002)

• Glascow Outcome Score all pts 15 25 (p=0.03)

• 0-5, 0-4* unfavorable - %)

• S. pneumoniae, n=108 (%) 26 52 (p=.006)

• *4= unable to return to work/school

Low-Dose Maintenance Corticosteroids in Septic Shock

• 28-day mortality

• Non-responders (n,%) 60/114 (53) 73/115 (63) (16%, p=.02)

• Responders (n,%) 22/36 (61) 18/34 (53)

• All patients (n,%) 82/150 (55) 91/149 (61)

Streptococcal Toxic Shock: IVIG

• 30 day survival (%) 67 34 (50%, p=.02)