We evaluated the costs of patients during their ICU stay, and its relation to clinical presentation (severe sepsis and septic shock), antibiotic start time, permanence of ICU stay, and mortality.
During the ICU hospitalization, the number of infected patients, the mean number of infections per patient, the infected sites, the occurrence of bacteremia, severe sepsis or septic shock, antibiotic use and its duration, the duration of mechanical ventilation, and development of acute respiratory distress syndrome (ARDS) or acute renal failure were noted.
Lung infection was the main source of septic shock and antibiotics administration delay was less than 3 h in the two groups.
Standard therapy for patients with septic shock includes antibiotics, infection source control, and hemodynamic support with fluids and vasoactive medications.
Mortality rates associated with severe B. pseudomallei infection approach 50% and can reach 80 95% in patients with septic shock despite antibiotic treatment [3], [4].
Several additional clusters contained significant numbers of host derived viral genes that potentially contribute to a variety of cellular processes such as vitamin B12 biosynthesis (cobS), host stress response (small heat shock proteins), antibiotic resistance (prnA) and nitrogen fixation (nifU) (Table S2).
Systemic factors – acute renal failure, multiple fractures, soft tissue destruction, haemorrhagic shock, transfusions, antibiotic therapy, parenteral nutrition – undoubtedly stressed the patient's immune status and facilitated fungal growth.
Addressing the time point of initial antibiotic administration, the patients were categorized into time from triage and into time from shock recognition to antibiotics [ 5].
We advise that in patients with severe sepsis or septic shock first-line antibiotics should remain broad spectrum with rigorous follow up to de-escalate as early as possible.
High-throughput 16S rRNA gene sequencing results confirmed that the bacterial community in the biofilm without the EPS was more vulnerable to antibiotic shock as indicated by the community diversity and richness indices.
