A multicentre case-control study of nonsteroidal anti-inflammatory drugs as a risk factor for severe sepsis and septic shock.
Crit Care. 2009 Mar 30;13(2):R43
Authors: Legras A, Giraudeau B, Jonville-Bera AP, Camus C, Francois B, Runge I, Kouatchet A, Veinstein A, Tayoro J, Villers D, Autret-Leca E
ABSTRACT: INTRODUCTION: We aimed to establish whether or not the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during evolving bacterial community-acquired infection in adults is associated with severe sepsis or septic shock. METHODS: We conducted a multicentre case-control study in eight intensive care units. Cases were all adult patients admitted for severe sepsis or septic shock due to a bacterial community-acquired infection. Controls were patients hospitalised with a mild community-acquired infection. Each case was matched to one control for age, presence of diabetes and site of infection. RESULTS: The main outcome measures were the proportions of cases and controls exposed to NSAIDs or aspirin during the observation period. In all, 152 matched pairs were analysed. The use of NSAIDs or aspirin during the observation period did not differ for cases and controls (27% versus 28, odds ratio (OR) 0.93, 95% confidence interval (CI) 0.52, 1.64). If aspirin was not considered, there was still no difference, and none if a distinction was made between acute and chronic drug treatment. However, for NSAID users, the median time to the prescription of effective antibiotic therapy was longer than for non-users (6 days, 95% CI 3, 7 versus 3 days, 95% CI 2, 3, P = 0.02). CONCLUSIONS: In this study, the use of NSAIDs or aspirin during evolving bacterial infection was frequent and concerned one quarter of the patients with such infection. Although the use of NSAIDs by patients with severe sepsis or septic shock did not differ from their use by those with mild infection at the same infected site, we observed a longer median time to the prescription of effective antibiotic therapy for NSAID users.
PMID: 19331665 [PubMed - as supplied by publisher]