Septic death in adults at Surin Hospital: an investigation of real-life clinical practice vs. empirical guidelines.

ABSTRACT

OBJECTIVE: To explore the cause of death from sepsis and to evaluate the hospital practice in septic patients. MATERIAL AND METHOD: A cross-sectional, retrospective study was conducted between October 2004 and September 2005, at Surin Hospital. The present study included 119 adults (> or = 15 year of age) who were admitted with community-acquired sepsis. RESULTS: According to the ACCP/SCCM definition, 85.7% of the patients had severe sepsis and up to 71.4% had septic shock. The overall hospital mortality was 73.9% for septic patients and 88.2% for patients in septic shock. The factors that were significantly associated with death from sepsis were age > or = 60 years, presence of co-morbidity, septic shock, organ dysfunctions > or = 3, and acidosis (HCO3 < 20 mEq/L). During hospitalization, 5.9% of patients received ICU care, 29.4% adequate fluid resuscitation, but none had been monitored for Svo2 or Scvo2, and 36.4% had more than a 1-hr delay in the administration of antibiotics. The main cause of death was refractory hypotension (77.3%), in which the amount of fluid therapy during initial resuscitation was significantly associated with the survival of septic shock. CONCLUSION: Septic shock is the most common cause of death in septic patients. Delayed and inadequate hemodynamic management, including a delay in the administration of antibiotics are the main problems in real-life clinical management of septic patients.