Our study highlighted several key aspects of the management of septic shock patients in our intensive care unit. The analysis revealed an incidence of 8.6% for septic shock, primarily affecting elderly patients with significant comorbidities, such as diabetes (47%) and hypertension (22%). These findings align with the literature, which indicates that patients with chronic comorbidities are more likely to develop septic shock due to their immunological and metabolic vulnerability [4-6].

1. Incidence of Septic Shock
The prevalence of septic shock observed in our study was 8.6%, a result consistent with international literature, where the incidence of septic shock typically ranges between 6% and 12% of ICU admissions [7]. A recent meta-analysis by Jean-Louis Vincent et al. reported incidence rates from 7% to 23% across various hospital settings [8]. Variations in reported rates may be attributed to methodological differences between studies, particularly regarding diagnostic criteria. Since the introduction of Sepsis-3 criteria, which are based on the SOFA score, estimates of sepsis and septic shock incidence have evolved, enabling more precise identification of severe cases requiring intensive care [8].

2. Demographic Characteristics and Comorbidities
The mean age of patients was 58.5 years, with a male predominance (sex ratio: 1.54). These findings align with recent studies indicating that septic shock primarily affects older individuals, with higher incidence rates among men [9,10]. This gender disparity may be related to hormonal and behavioral factors that influence immune response and exposure to risk factors [9].

The role of comorbidities, particularly diabetes (47%) and hypertension (22%), is well-documented in the literature. These conditions increase susceptibility to infections and exaggerated inflammatory responses [4,5].

3. Clinical and Biological Manifestations
The clinical data, including fever, tachypnea, and hemodynamic instability, along with biological abnormalities such as anemia, thrombocytopenia, and hypoalbuminemia, observed in our study are well-established markers of septic shock [7]. Fever reflects a systemic inflammatory response to an underlying infection, while tachypnea is often associated with metabolic acidosis or pulmonary dysfunction, indicating the severity of respiratory failure [11]). Hemodynamic instability, a key criterion for septic shock according to Sepsis-3 definitions, manifests as hypotension requiring vasopressors to maintain adequate perfusion [7].

Biologically, anemia may result from blood loss or marrow suppression due to inflammation, while thrombocytopenia is often linked to excessive platelet consumption, particularly in disseminated intravascular coagulation (DIC) [11]. Hypoalbuminemia reflects capillary leakage caused by endothelial dysfunction and is an indicator of severity [12,13]. Collectively, these parameters underscore the complex pathophysiology of septic shock, involving excessive inflammation, vascular dysregulation, and multiorgan failure, which are essential for diagnosis and management.

4. Timing of Antibiotic Administration
Only 48.7% of patients in our study received antibiotics before ICU admission. This delay can be attributed to several context-specific factors, including limited immediate availability of certain antibiotics, prolonged diagnostic delays due to restricted access to microbiological tools, and late recognition of clinical symptoms in patients often admitted in critical condition.

Current guidelines, such as the 2021 Surviving Sepsis Campaign, emphasize the importance of administering broad-spectrum antibiotics within one hour of diagnosing septic shock to limit infection progression and reduce the risk of organ failure [14]. Studies have shown that delayed initiation of antibiotic therapy is closely associated with a significant increase in mortality. For instance, each hour of delay correlates with a 7.6% increase in mortality, highlighting the critical importance of prompt management [15,16]. These results underscore the need to strengthen diagnostic and therapeutic protocols to ensure timely initiation of antibiotic treatment in line with best clinical practices.

5. Choice of Antibiotics and Combinations
Metronidazole (86.3%) and third-generation cephalosporins (66.6%) were the most frequently used antibiotics, reflecting a strategy aimed at covering a wide range of pathogens, including anaerobes and Gram-negative bacilli, commonly involved in abdominal and polymicrobial infections associated with septic shock [17]).

The administration of multiple antibiotics simultaneously—sometimes up to six agents—while potentially justified for complex or resistant infections, raises significant concerns. These combinations increase the risks of toxicity, opportunistic infections like Clostridioides difficile, and bacterial resistance, a particularly critical issue in intensive care [18]. International guidelines, such as the 2016 Surviving Sepsis Campaign, recommend systematic reevaluation of antibiotic therapy after 48–72 hours based on microbiological results to reduce overuse and optimize targeted treatment

(16). These findings highlight the importance of implementing antimicrobial stewardship programs in ICUs to streamline antibiotic use, minimize bacterial resistance, reduce adverse effects, and optimize associated costs [19].

6. Duration of Antibiotic Therapy
The average duration of antibiotic treatment in our study was 6.61 days, slightly below current recommendations, which suggest a duration of 7 to 10 days for most severe infections, depending on clinical response and microbiological data [16].

An inappropriate treatment duration, particularly if too short, was clearly associated with increased mortality in our study, a finding corroborated by the literature. Hellyer et al. demonstrated that short durations increase the risk of relapse, persistent infection, or resistance emergence, while excessive prolongation may lead to side effects and microbiome imbalances [20]. The use of biomarkers such as procalcitonin can help individualize and optimize treatment duration, reducing unnecessary exposure while maintaining equivalent clinical efficacy [21]. Rigorous clinical assessment is essential to adjust antibiotic durations and improve outcomes in sepsis or septic shock patients.

7. Impact of Antibiotic Therapy on Mortality
Our study revealed an overall mortality rate of 67.2%, with higher mortality among patients who did not receive antibiotics before ICU admission. Recent guidelines, including the 2021 Surviving Sepsis Campaign, emphasize the administration of broad-spectrum antibiotics within one hour of diagnosing septic shock, significantly reducing mortality [14]. Inappropriate antibiotic therapy, as identified through the Gyssens classification, was associated with increased mortality, corroborating findings by Weinberger et al., who demonstrated that inadequate treatment doubles the risk of death [22]. Combining prompt initiation with adjustments based on microbiological results is crucial to improving outcomes.

8. Impact of SOFA Score on Mortality and the Role of Prior Antibiotic Therapy
The SOFA score is a key tool for assessing organ failure and predicting mortality in sepsis patients. Our study shows a direct correlation between higher SOFA scores and mortality, with scores above 5 significantly associated with increased risk. These findings align with recent literature showing that each one-point increase in the SOFA score is linked to a significant rise in mortality.

Huang et al. developed a model combining the SOFA score with comorbidity indices, demonstrating superior performance in predicting hospital mortality in sepsis [23]. Furthermore, dynamic trajectories of the SOFA score within the first 72 hours, as analyzed by Palmowski et al., were robust predictors of 30-day mortality [24].

Regarding antibiotic therapy, our study reveals that its administration before ICU admission does not directly impact SOFA score trajectories, although rapid initiation is associated with an overall reduction in mortality. Karakike et al. showed that early SOFA score changes, particularly within the first seven days, are key indicators of treatment response and survival in septic shock [25]. Li et al. highlighted the importance of integrating the SOFA score with other parameters, such as procalcitonin, to optimize survival predictions and guide therapeutic decisions [26]. These results confirm that while the SOFA score is a reliable predictor, its utility is enhanced when integrated into a multimodal approach, including the timeliness and optimization of antibiotic therapy.

9. Study Limitations
Our study has certain limitations inherent to its retrospective nature, such as reliance on available medical records and the absence of specific microbiological data. However, as a single-center study, it provides a detailed and contextualized analysis of local practices, although validation in larger populations may be needed to confirm the generalizability of the results.