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Epidemiology of sepsis in Germany: results from a national prospective multicenter study

Christoph Engel| Frank M. Brunkhorst| Hans-Georg Bone| Reinhard Brunkhorst| Herwig Gerlach| Stefan Grond| Matthias Gruendling| Guenter Huhle| Ulrich Jaschinski| Stefan John| Konstantin Mayer| Michael Oppert| Derk Olthoff| Michael Quintel| Max Ragaller| Rolf Rossaint| Frank Stuber| Norbert Weiler| Tobias Welte| Holger Bogatsch| Christiane Hartog| Markus Loeffler| Konrad Reinhart
Original
Volume 33, Issue 4 / April , 2007

Pages 606 - 618

Abstract

Objective

To determine the prevalence and mortality of ICU patients with severe sepsis in Germany, with consideration of hospital size.

Design

Prospective, observational, cross-sectional 1-day point-prevalence study.

Setting

454 ICUs from a representative nationwide sample of 310 hospitals stratified by size. Data were collected via 1-day on-site audits by trained external study physicians. Visits were randomly distributed over 1 year (2003).

Patients

Inflammatory response of all ICU patients was assessed using the ACCP/SCCM consensus conference criteria. Patients with severe sepsis were followed up after 3 months for hospital mortality and length of ICU stay.

Measurements and results

Main outcome measures were prevalence and mortality. A total of 3,877 patients were screened. Prevalence was 12.4% (95% CI, 10.9–13.8%) for sepsis and 11.0% (95% CI, 9.7–12.2%) for severe sepsis including septic shock. The ICU and hospital mortality of patients with severe sepsis was 48.4 and 55.2%, respectively, without significant differences between hospital size. Prevalence and mean length of ICU stay of patients with severe sepsis were significantly higher in larger hospitals and universities (≤ 200 beds: 6% and 11.5 days, universities: 19% and 19.2 days, respectively).

Conclusions

The expected number of newly diagnosed cases with severe sepsis in Germany amounts to 76–110 per 100,000 adult inhabitants. To allow better comparison between countries, future epidemiological studies should use standardized study methodologies with respect to sepsis definitions, hospital size, and daily and monthly variability.

Keywords

References

  1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310
    • View reference on PubMed
    • View reference on publisher's website
  2. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554
    • View reference on PubMed
    • View reference on publisher's website
  3. Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, Sicignano A, Palazzo M, Moreno R, Boulme R, Lepage E, Le Gall R (2002) Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med 28:108–121
  4. Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J (2004) Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med 30:589–596
  5. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. J Am Med Assoc 274:968–974
    • View reference on publisher's website
  6. Brun-Buisson C, Meshaka P, Pinton P, Vallet B (2004) EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med 30:580–588
  7. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. J Am Med Assoc 273:117–123
    • View reference on publisher's website
  8. Zahorec R, Firment J, Strakova J, Mikula J, Malik P, Novak I, Zeman J, Chlebo P (2005) Epidemiology of severe sepsis in intensive care units in the Slovak Republic. Infection 33:122–128
    • View reference on PubMed
    • View reference on publisher's website
  9. Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, Parsonnet J, Panzer R, Orav EJ, Snydman DR, Black E, Schwartz JS, Moore R, Johnson BL Jr, Platt R (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. J Am Med Assoc 278:234–240
    • View reference on publisher's website
  10. Sprung CL, Sakr Y, Vincent JL, Le Gall JR, Reinhart K, Ranieri VM, Gerlach H, Fielden J, Groba CB, Payen D (2006) An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence in Acutely Ill Patients (SOAP) study. Intensive Care Med 32:421–427
  11. Ponce de Leon-Rosales SP, Molinar-Ramos F, Dominguez-Cherit G, Rangel-Frausto MS, Vazquez-Ramos VG (2000) Prevalence of infections in intensive care units in Mexico: a multicenter study. Crit Care Med 28:1316–1321
    • View reference on PubMed
    • View reference on publisher's website
  12. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. J Am Med Assoc 274:639–644
    • View reference on publisher's website
  13. van Gestel A, Bakker J, Veraart CP, van Hout BA (2004) Prevalence and incidence of severe sepsis in Dutch intensive care units. Crit Care 8:R153–R162
    • View reference on PubMed
    • View reference on publisher's website
  14. Sundararajan V, Macisaac CM, Presneill JJ, Cade JF, Visvanathan K (2005) Epidemiology of sepsis in Victoria, Australia. Crit Care Med 33:71–80
    • View reference on PubMed
    • View reference on publisher's website
  15. Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K (2003) Epidemiology of severe sepsis occurring in the first 24 h in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 31:2332–2338
    • View reference on PubMed
    • View reference on publisher's website
  16. Moss M, Martin GS (2004) A global perspective on the epidemiology of sepsis. Intensive Care Med 30:527–529
  17. Anonymous (1997) Systematisches Verzeichnis der Krankenhaeuser und Vorsorge- oder Rehabilitationseinrichtungen in Deutschland – Stand 31.12.1995
  18. Hansen HP, Hurwitz WN (1943) On the theory of sampling from finite populations. Ann Math Stat 14:333–362
  19. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140
    • View reference on PubMed
    • View reference on publisher's website
  20. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. J Am Med Assoc 270:2957–2963
    • View reference on publisher's website
  21. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
    • View reference on PubMed
    • View reference on publisher's website
  22. Freeman J, Hutchison GB (1980) Prevalence, incidence and duration. Am J Epidemiol 112:707–723
    • View reference on PubMed
  23. Warren HS, Suffredini AF, Eichacker PQ, Munford RS (2002) Risks and benefits of activated protein C treatment for severe sepsis. N Engl J Med 347:1027–1030
    • View reference on PubMed
    • View reference on publisher's website
  24. Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709
    • View reference on PubMed
    • View reference on publisher's website
  25. Panacek EA, Marshall JC, Albertson TE, Johnson DH, Johnson S, MacArthur RD, Miller M, Barchuk WT, Fischkoff S, Kaul M, Teoh L, Van Meter L, Daum L, Lemeshow S, Hicklin G, Doig C (2004) Efficacy and safety of the monoclonal anti-tumor necrosis factor antibody F(ab')2 fragment afelimomab in patients with severe sepsis and elevated interleukin-6 levels. Crit Care Med 32:2173–2182
    • View reference on PubMed
  26. Wenzel RP, Edmond MB (2001) Severe sepsis-national estimates. Crit Care Med 29:1472–1474
    • View reference on PubMed
    • View reference on publisher's website
  27. Wild C, Narath M (2003) Evidenzbasierte Intensivbettenplanung: Eine Übersicht zu rezenten internationalen Planungen und Planungsansätzen. Intensivmedizin und Notfallmedizin 40:412–419
    • View reference on publisher's website
  28. Anonymous (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

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