Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2006;10(4):R111.
doi: 10.1186/cc4995.

Timing of adequate antibiotic therapy is a greater determinant of outcome than are TNF and IL-10 polymorphisms in patients with sepsis

Jose Garnacho-Montero  1 , Teresa Aldabo-Pallas, Carmen Garnacho-Montero, Aurelio Cayuela, Rocio Jiménez, Sonia Barroso, Carlos Ortiz-Leyba
Affiliations
Comparative Study

Timing of adequate antibiotic therapy is a greater determinant of outcome than are TNF and IL-10 polymorphisms in patients with sepsis

Jose Garnacho-Montero et al. Crit Care. 2006.

Abstract

Introduction: Genetic variations may influence clinical outcomes in patients with sepsis. The present study was conducted to evaluate the impact on mortality of three polymorphisms after adjusting for confounding variables, and to assess the factors involved in progression of the inflammatory response in septic patients.

Method: The inception cohort study included all Caucasian adults admitted to the hospital with sepsis. Sepsis severity, microbiological information and clinical variables were recorded. Three polymorphisms were identified in all patients by PCR: the tumour necrosis factor (TNF)-alpha 308 promoter polymorphism; the polymorphism in the first intron of the TNF-beta gene; and the IL-10-1082 promoter polymorphism. Patients included in the study were followed up for 90 days after hospital admission.

Results: A group of 224 patients was enrolled in the present study. We did not find a significant association among any of the three polymorphisms and mortality or worsening inflammatory response. By multivariate logistic regression analysis, only two factors were independently associated with mortality, namely Acute Physiology and Chronic Health Evaluation (APACHE) II score and delayed initiation of adequate antibiotic therapy. In septic shock patients (n = 114), the delay in initiation of adequate antibiotic therapy was the only independent predictor of mortality. Risk factors for impairment in inflammatory response were APACHE II score, positive blood culture and delayed initiation of adequate antibiotic therapy.

Conclusion: This study emphasizes that prompt and adequate antibiotic therapy is the cornerstone of therapy in sepsis. The three polymorphisms evaluated in the present study appear not to influence the outcome of patients admitted to the hospital with sepsis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Correlation between delta-SOFA and delayed initiation of adequate antibiotic therapy. SOFA, Sequential Organ Failure Assessment.
See this image and copyright information in PMC

References

    1. Angus DC, Linde-Zwirble WT, Lidicker L, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310. doi: 10.1097/00003246-200107000-00002. - DOI - PubMed
    1. Annane D, Aegerter P, Jars-Guincestre MC, Guidet B, CUB-Rea Network Current epidemiology of septic shock. Am J Respir Crit Care Med. 2003;168:165–172. doi: 10.1164/rccm.2201087. - DOI - PubMed
    1. Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med. 2003;31:2742–2751. doi: 10.1097/01.CCM.0000098031.24329.10. - DOI - PubMed
    1. Valles J, Rello J, Ochagavia A, Garnacho J, Alcala MA. Community-acquired bloodstream infection in critically ill adult patients: impact of shock and inappropriate antibiotic therapy on survival. Chest. 2003;123:1615–1624. doi: 10.1378/chest.123.5.1615. - DOI - PubMed
    1. Yu DT, Black E, Sands KE, Schwartz JS, Hibberd PL, Graman PS, Lanken PN, Kahn KL, Snydman DR, Parsonnet J, et al. Severe sepsis: variation in resource and therapeutic modality use among academic centers. Crit Care. 2003;7:R24–R34. doi: 10.1186/cc2171. - DOI - PMC - PubMed

Publication types