Clinical Microbiology and Antimicrobial Chemotherapy. 2003; 5(2):144-152
This paper presents retrospective analysis of currently existing approaches to the medical treatment of severe sepsis and septic shock in patients from 7hospitals in 6 Russian cities. Two hundreds and eighty eight patients aged 16 to 75 years were included in this study. The most common diagnosis was sepsis associated with intra-abdominal infections (63,9%). Systemic antimicrobials (100%), unfractionated heparin (63,9%), corticosteroids (35,1%), protease inhibitors (26,8%) were the most frequently administered medications. Artificial colloidal solutions, primarily a dextrans (96% of cases), fresh frozen plasma and albumin were added to treatment regimens in 57,9%, 45,2% and 24,3% of patients, respectively. The most commonly administered antimicrobials were aminoglycosides (28,2%), penicillins (24,7%) and first-generation cephalosporins (9,7%). Combination regimens were used in 90% of patients. Choice of empiric antimicrobials and a number of used medications varied in different hospitals. Change of empiric regimens and multiple courses of antimicrobial therapy were experienced in 63,9% of cases. There have shown to be great differences between the currently existing practice of medical treatment of sepsis in Russian ICUs and national and international guidelines. These include inadequate initial antimicrobial therapy and dosing regimens as well as unjustified use of medications with unproven clinical efficacy.