Question special
Resident

The mortality rates among the control groups in the Rivers trial (46%) and the PRISM study (25.4%) are striking. Rivers cited a 49% mortality rate for sepsis at that time where today studies are reporting a mortality rate of ~30%. This meta-analysis is showing that intensive monitoring and aggressive fluids is likely not the difference. Many other studies have showed that early antibiotics (<3 hours) show a definite mortality difference. Both groups in the PRISM study received antibiotics in this time period whereas in the Rivers trial antibiotics in the control group were left to the discretion of the physician. Could this account for the difference in mortality? What else have learned over the past 15 years that could be contributing to the overall decrease in mortality among septic patients?