Empirical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome.

eptic shock is the most com-mon cause of death in inten-sive care units (ICUs). Mortal-ity ranges from 40% to 60% inpatients with septic shock (1). Antimicro-bial therapy is recognized as the corner-stone of treatment of these patients (2, 3).The prescribing of antimicrobial therapyis usually empirical, given the critical na-ture of this illness. The choice of appro-priate antimicrobial therapy in this set-ting is crucial in curtailing theemergence of resistance and containingthe cost (4). The importance of providingearly antimicrobial therapy, which is ef-fective against the pathogens responsiblefor various infectious diseases, has beenhighlighted by several clinical studies (5–10). These studies have shown that theadministration of inadequate antimicro-bial treatment seems to be an increas-ingly important risk factor for hospitalmortality. Surprisingly, despite the wide-spread use of antimicrobial therapy totreat septic shock patients, few clinicalinvestigations have determined the con-sequence of the administration of inade-quate antibiotic treatment on the out-come of these patients (1).To better understand current pre-scribing practices and to assess links be-tween empirical antimicrobial therapyand patient outcome, we designed a pro-spective study with the following goals: 1)to describe the antimicrobial therapy pre-scribed for septic shock patients, 2) toassess the activity of this antimicrobialtherapy against identified etiologic agentsof infection, and 3) to evaluate the rela-tionship between the inadequate antimi-crobial treatment and outcome of septicshock patients (30-day mortality).