Epidemiology of Community-Acquired Sepsis: Data from an E-Sepsis Registry of a Tertiary Care Center in South India (original) (raw)
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Epidemiology of adult-population sepsis in India: A single center 5 year experience
Indian Journal of Critical Care Medicine, 2017
Research Article IntroductIon Sepsis is a major cause of morbidity and mortality and the second leading cause of death worldwide. [1] Epidemiologic data on sepsis varies depending on the origin of database-community-based or hospital-based, nature of data collection-retrospective chart review, discharge diagnoses, diagnosis in death certificates, or prospective observational studies. A robust epidemiological study methodology should be prospective in nature conducted over a prolonged period and should include heterogeneous case mix representative of the disease, thus allowing generalizability of observed data. Epidemiological data on sepsis come mostly from western literature. [1-6] Data from India are sparse and in the form of epidemiology of infection (both community and hospital acquired) rather than sepsis which is a host response to infection. [7-10] Moreover, literature and surveys conducted in India concentrate on the microbiological profile, resistance pattern, antibiotic usage, and outcome rather than sepsis epidemiology. To address this deficiency, we conducted a prospective observational study on severe sepsis for 5 years in a tertiary care hospital in India. subjects and Methods Study setting This study was conducted as a prospective observational cohort study at a 43-bedded Intensive Care Unit (ICU) (medical and surgical, neurology, and trauma care) of a tertiary care hospital in India. The study protocol was reviewed by the hospital ethical committee and informed consent was waived because the nature of this study was observational. Background and Aims: Sepsis is a major worldwide cause of morbidity and mortality. Most sepsis epidemiologic data are from the Western literature. Sparse data from India describe the epidemiology of infection rather than sepsis which is a host response to infection. This study describes the epidemiology of sepsis in the Intensive Care Unit (ICU) of an Indian tertiary care hospital. Subjects and Methods: A prospective study conducted between June 2006 and May 2011. All consecutively admitted patients during the 5 year study >=18 years of age were included and data obtained from hospital in-patient records. Variables measured were the incidence of severe sepsis, ICU, hospital, and 28-day mortality, the median length of ICU stay, median Acute Physiology and Chronic Health Evaluation II (APACHE II) score, infection site, and microbial profile. Results: There were 4711 admissions during the study with 282 (6.2%, 95% confidence interval 2.3, 13.1) admissions with severe sepsis. ICU mortality, hospital mortality, and 28-day mortality were 56%, 63.6%, and 62.8%, respectively. Predominant infection site was respiratory tract. The most common organisms were Gram-negative microbes. The most common microbe was Acinetobacter baumanni. Median APACHE II score on admission was 22 (interquartile range 16-28) and median length of ICU stay was 8 days. Severe sepsis attributable mortality was 85%. Conclusion: Severe sepsis is common in Indian ICUs and is mainly due to Gram-negative organisms. ICU mortality is high in this group and care is resource intensive due to increased length of stay.
Epidemiology and outcome of sepsis in a tertiary-care hospital in a developing country
Epidemiology and Infection, 2006
Sepsis continues to have a substantial mortality and morbidity despite advances in the diagnosis and management of this condition. We retrospectively analysed hospital charts of patients diagnosed to have sepsis between January 2002 and June 2003. Demographic characteristics of patients, microbiological findings and predictors of survival were evaluated. Sixty-nine sepsis episodes that occurred in 63 patients were analysed. The most common underlying diseases were hypertension, malignancies and diabetes mellitus. Renal insufficiency, respiratory distress and disseminated intravascular coagulation developed in 52 . 2, 30 . 4 and 30 . 4 % of the episodes respectively ; 47 . 7 % of the blood cultures yielded an organism. Gram-negative bacteria were the predominant microorganisms (65 . 9 %). Fifty-five patients (87 . 3 %) died. Mechanical ventilation and underlying renal disease were significant determinants of mortality. In conclusion, Gram-negative bacteria remain the major pathogens in sepsis. The mortality remains very high, and a change in the clinical approach to the septic patient should be employed to improve the outcome.
2019
Introduction: Blood stream infections can lead to sepsis. Bacteria causing sepsis show multi-drug resistance which increases the morbidity and mortality in sepsis patients. The present study conducted to isolate the bacteria causing sepsis and their antibiotic susceptibility pattern in adult patients. Material and methods: A total number of 296 blood samples of adult patients with sepsis were taken and processed as per standard protocol. Identification of bacteria was carried out according to the standard biochemical tests. Antimicrobial susceptibility test was carried out on Mueller Hinton agar plates by the KirbyBauer disk diffusion method, according to the Central Laboratory Standards Institute guidelines. Results: Bacteria were isolated in 79 samples (26.69%). 54 isolates (68.35%) were gram negative bacilli and 25 isolates (31.65%) were gram positive cocci. Klebsiella spp. and Staphylococcus aureus were the predominant isolates among gram negative and gram positive bacteria resp...
Epidemiology of sepsis in Siriraj Hospital 2007
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2009
Sepsis remains a major health burden, and there is limited epidemiological report of sepsis in Thailand. To determine the epidemiology, treatments, clinical courses and outcomes of sepsis patients. All sepsis patients in medical wards at Siriraj Hospital were recruited from February 1 to July 31, 2007. The information from patients' medical records were retrieved and analyzed. From 3,451 patients, 201 (5.8%) were diagnosed as sepsis, and 38.8% of these developed septic shock. Among sepsis patients, 62.2% were community acquired, 40.8% had bacteremia, and gram negative bacteria were the common pathogen (51.7%). Appropriate antibiotics were given within 6 hours in 39%. Goal-directed therapy was achieved in only 11.5%. The mortality among sepsis and septic shock patients was 34.3% and 52.6%, respectively (p = 0.008). Risk factors for hospital mortality included higher maximum SOFA score, hospital-acquired infection, central nervous system dysfunction and receiving antibiotics after...
BioMed Research International
The global incidence of sepsis is increasing, and mortality remains high. The mortality is even higher in resource-poor countries where facilities and equipment are limited. The Surviving Sepsis Campaign (SSC) recommends an updated hour-1 bundle based on the evidence from the International Guidelines for Management of Sepsis and Septic Shock 2018. To reduce mortality from sepsis, compliance with the “bundle” is essential. Data from developing countries like Sri Lanka on the management of sepsis according to the SSC guidelines are not available. Hence, this study looks at the patient characteristics and management of septic patients at a tertiary care hospital in Sri Lanka. Patients admitted to the University Medical Unit of Colombo South Teaching Hospital from January to August 2019 fulfilling the inclusion criteria were included. The hour-1 sepsis bundle adherence, demographic data, and management were recorded. There were 387 patients: 163 males and 224 females. The age range was ...
International Journal of Research in Medical Sciences
Background: Sepsis is a life-threatening medical condition triggered due to body's response to an infection. If empirical treatment for sepsis and bacteraemia is held up it will increase chances of mortality as well as duration of stay and cost. Hence, there is a need for risk stratification. So, we planned to study the clinicohematological profile of patients of sepsis admitted to this hospital in ICU.Methods: This was an observational study. A total of 50 patients of sepsis were included. All included participants were subject to CBC, RFT, LFT, RBS, Urine RM, ESR, chest X-ray, USG Abdomen. Laboratory evaluations were performed in the institutional pathology and biochemistry labs. Data was analysed to assess the clinicohematological profile of the patients of sepsis to identify common factors which if taken care of in time can reduce development to sepsis and the morbidity and mortality related to it.Results: Most common presenting complaint was fever (72%), followed by altere...
Descriptive analysis of sepsis in a developing country
International Journal of Emergency Medicine, 2015
Background Most studies on sepsis were conducted in developed countries. The aim of this study is to report on a series of patients with sepsis in a tertiary hospital in a developing country. Methods Patients admitted through the emergency department of a single university-based institution between January 2008 and June 2012, with a final diagnosis of sepsis, bacteremia, or septic shock, were retrieved. A sample of 97 patients was selected. Vital signs at presentation, number of SIRS criteria, use of vasopressors and steroids, and in-hospital mortality were recorded. Results The mean age was 70.09 ± 16.82, ranging from 19 to 96 years; 48.5 % were females and 51.5 % were males; 42.3 % of the patients were found to be bacteremic. IV fluid requirement during the first 6 h was 1.75 ± 1.96 l. The time for antibiotic initiation was 3.43 ± 4.48 h, with 87.6 % of the antibiotics initiated in the emergency department. Norepinephrine was the most commonly used vasopressor (38.1 %) followed by...
Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes
Sepsis has been around since the dawn of time, having been described for more than 2000 years, although clinical definitions are recent. The consensus sepsis definitions have permitted worldwide epidemiological studies of sepsis to be conducted. We now recognize the common nature of sepsis and the consistency of its disease -particularly severe sepsis and septic shock. The incidence of sepsis, severe sepsis and septic shock continues to increase, and although Grampositive bacterial pathogens remain the most common cause of sepsis, fungal organisms are increasing rapidly. We have made progress over the past half-century in identifying and treating patients with sepsis, and decreasing fatality rates reflect this progress. However, owing to the increasing incidence of sepsis, the number of people who die each year continues to increase. The mortality with sepsis, particularly related to treating organ dysfunction, remains a priority to clinicians worldwide and is deserving of greater public health attention.
Critical Care Research and Practice, 2012
Our aim was to determine the risk factors on mortality in adult patients with community-acquired severe sepsis and septic shock. The main outcome measure was hospital mortality. This prospective single centre study was conducted from January 1, 2008 to December 31, 2010, and included 184 patients, of whom 135 (73.4%) were with severe sepsis and 49 (26.6%) had septic shock. Overall, ninety-five (51.6%) patients have died, 60 (44.4%) in severe sepsis and 35 (71.4%) patients with septic shock. The lung was the most common site of infection 121 (65.8%), and chronic heart failure was the most frequent comorbidity 65 (35.3%). Logistic multivariate analysis identified three independent risk factors for mortality in patients with severe sepsis: positive blood culture (odds ratio, 2.39; 95% confidence interval, 1.13-5.06; P = 0.02), three or more organ dysfunctions (odds ratio, 3.93; 95% confidence interval, 1.62-9.53; P = 0.002), and Simplified Acute Physiology Score (SAPS) II (odds ratio, 1.02; 95% confidence interval, 1.00-1.04; P = 0.01). In addition to SAPS II, positive blood culture, and three or more organ dysfunctions are important independent risk factors for mortality in patients with severe sepsis and septic shock.