Survival Analysis of 314 Episodes of Sepsis in Medical Intensive Care Unit in University Hospital: Impact of Intensive Care Unit Performance and Antimicrobial Therapy

Degoricija, Vesna; Sharma, Mirella; Legac, Ante; Gradišer, Marina; Šefer, Siniša; Vučičević, Željko
June 2006
Croatian Medical Journal;2006, Vol. 47 Issue 3, p385
Academic Journal
Aim To evaluate epidemiology of sepsis in medical intensive care unit (ICU) in a university hospital, and the impact of ICU performance and appropriate empirical antibiotic therapy on survival of septic patients. Methods Observational, partly prospective study conducted over 6 years assessed all patients meeting the criteria for sepsis at ICU admission at the Sisters of Mercy University Hospital. Clinical presentation of sepsis was defined according to 2001 International Sepsis Definitions Conference. Demographic data, admission category, source of infection, severity of sepsis, ICU or hospital stay and outcome, ICU performance, and appropriateness of empirical antibiotic therapy were analyzed. Results The analysis included 314 of 5022 (6.3%) patients admitted to ICU during the study period. There were 176 (56.1%) ICU survivors. At the ICU admission, sepsis was present in 100 (31.8%), severe sepsis in 89 (28.6%), and septic shock in 125 (39.8%) patients with mortality rates 17%, 33.7%, 72.1%, respectively. During ICU treatment, 244 (77.7%) patients developed at least one organ dysfunction syndrome. Of 138 (43.9%) patients who met the criteria for septic shock, 107 (75.4) were non-survivors (P<0.001). Factors associated with in-ICU mortality were acquisition of sepsis at another department (odds ratio [OR] 0.06; 95% confidence interval [CI], 0.02-0.19), winter season (OR 0.42; 0.20-0.89), limited mobility (OR 0.28; 0.14-0.59), ICU length of stay (OR 0.82; 0.75-0.91), sepsis-related organ failure assessment (SOFA) score on day 1 (OR 0.80; 0.72-0.89), history of global heart failure (OR 0.33; 0.16-0.67), chronic obstructive pulmonary disease (COPD)-connected respiratory failure (OR 0.50; 0.27-0.93), septic shock present during ICU treatment (OR 0.03; 0.01-0.10), and negative blood culture at admission (OR 2.60; 0.81-6.23). Microbiological documentation of sepsis was obtained in 235 (74.8%) patients. Urinary tract infections were present in 168 (53.5%) patients, followed by skin or soft tissue infections in 58 (18.5%) and lower respiratory tract infections in 44 (14.0%) patients. Lower respiratory tract as focus of sepsis was connected with worse outcome (P<0.001). Empirical antibiotic treatment was considered adequate in 107 (60.8%) survivors and 42 (30.4%) non-survivors. Patients treated with adequate empirical antibiotic therapy had significantly higher survival time in hospital (log-rank, P = 0.001).Conclusion The mortality rate of sepsis was unacceptably high. The odds for poor outcome increased with acquisition of sepsis at another department, winter season, limited mobility, higher SOFA score on day 1, history of chronic global heart failure, COPD-connected respiratory failure, and septic shock present during ICU treatment, whereas longer ICU length of stay, positive blood culture, and adequate empirical antibiotic therapy were protective factors.


Related Articles

  • Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia. Dick, Andrew; Hangsheng Liu; Zwanziger, Jack; Perencevich, Eli; Furuya, E. Yoko; Larson, Elaine; Pogorzelska-Maziarz, Monika; Stone, Patricia W. // BMC Health Services Research;2012, Vol. 12 Issue 1, p432 

    Background: Hospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly...

  • Soluble L-selectin levels predict survival in sepsis. Seidelin, Jakob B.; Nielsen, Ole H.; Strøm, Jens // Intensive Care Medicine;Nov2002, Vol. 28 Issue 11, p1613 

    Objective. To evaluate serum soluble L-selectin as a prognostic factor for survival in patients with sepsis. Design. A prospective study of mortality in patients with sepsis whose serum levels of sL-selectin were measured on admission to an intensive care unit (ICU) and 4 days later. Follow-up...

  • Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Moerer, Onnen; Schmid, Alexandra; Hofmann, Michael; Herklotz, Anja; Reinhart, Konrad; Werdan, Karl; Schneider, Heinz; Burchardi, Hilmar // Intensive Care Medicine;Oct2002, Vol. 28 Issue 10, p1440 

    Objective. To determine the direct costs of severe sepsis patients in German intensive care units (ICUs). Design. Retrospective electronic data analysis. Setting. Three adult intensive care units (surgical/medical) in three university hospitals in Germany. Patients. 385 patients identified by...

  • Incidence and mortality of severe sepsis in surgical intensive care patients: the influence of patient gender on disease process and outcome. Wichmann, M. W.; Inthorn, D.; Andress, H.-J.; Schildberg, F. W. // Intensive Care Medicine;Feb2000, Vol. 26 Issue 2, p167 

    Objective: Laboratory studies demonstrated significant detrimental effects of male sex-steroids (testosterone) on immune functions following hemorrhagic shock and soft-tissue trauma. Moreover, better survival of female mice subjected to severe sepsis was observed when compared to male animals....

  • Are small hospitals with small intensive care units able to treat patients with severe sepsis? Reinikainen, Matti; Karlsson, Sari; Varpula, Tero; Parviainen, Ilkka; Ruokonen, Esko; Varpula, Marjut; Ala-Kokko, Tero; Pettilä, Ville // Intensive Care Medicine;Apr2010, Vol. 36 Issue 4, p673 

    To find out whether mortality from sepsis is influenced by the size of the hospital and of the intensive care unit (ICU). In the Finnsepsis study, 470 patients with severe sepsis were identified. The present study is a retrospective subgroup analysis of the Finnsepsis study. Eighteen patients...

  • Erworbene Muskelschwäche des kritisch Kranken. Ponfick, M.; Bösl, K.; Lüdemann-Podubecka, J.; Neumann, G.; Pohl, M.; Nowak, D.A.; Gdynia, H.-J. // Der Nervenarzt;Feb2014, Vol. 85 Issue 2, p195 

    The diagnosis of intensive care unit acquired weakness (ICUAW) in the setting of neurological rehabilitation is steadily increasing. This is due to the fact that the intensive care of patients with sepsis or after cardiac or abdominal surgery is improving. A longer duration of respiratory...

  • Sepsis is increasing in the general population and ITU care may be underutilised. Parsons, A. // Thorax;Oct2007, Vol. 62 Issue 10, p910 

    The article discusses a study which examines several cases of sepsis in the general population in Great Britain. It has been found that sepsis cases in hospitals are increasing. For this reason, some intensive care units (ITU) in the country is expected to be underutilized. Information about the...

  • Globicatella Bacteraemia Identified by 16S Ribosomal RNA Gene Sequencing. Lau, S. K. P.; Woo, P. C. Y.; Li, N. K. H.; Teng, J. L. L.; Leung, K. -W.; Ng, K. H. L.; Que, T. -L.; Yuen, K. -Y. // Journal of Clinical Pathology;Mar2006, Vol. 59 Issue 3, p303 

    Background: Globicatella are streptococcus-like organisms that have been rarely isolated from clinical specimens. Their epidemiology and clinical significance remain largely unknown. Aims: To describe two cases of Globicatella bacteraemia identified by 16S ribosomal RNA (rRNA) gene sequencing....

  • Intrapartum antibiotic prophylaxis and early-onset neonatal sepsis patterns. Edwards, Rodney K.; Jamie, Whitney E.; Sterner, Donald; Gentry, Susan; Counts, Kathy; Duff, Patrick // Infectious Diseases in Obstetrics & Gynecology;2003, Vol. 11 Issue 4, p221 

    Objective: To compare the relative effects of intrapartum antibiotic prophylaxis regimens on patterns of early-onset neonatal sepsis. Methods: We performed an historical cohort study of 17 187 infants born at our center from September 1993 to February 2000. A risk-based strategy was employed...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics