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Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study


ORIGINAL
Volume 42, Issue 12 / December , 2016

Pages 1980 - 1989

Abstract

Purpose

To estimate the incidence density, point prevalence and outcome of severe sepsis and septic shock in German intensive care units (ICUs).

Methods

In a prospective, multicentre, longitudinal observational study, all patients already on the ICU at 0:00 on 4 November 2013 and all patients admitted to a participating ICU between 0:00 on 4 November 2013 and 2359 hours on 1 December 2013 were included. The patients were followed up for the occurrence of severe sepsis or septic shock (SEPSIS-1 definitions) during their ICU stay.

Results

A total of 11,883 patients from 133 ICUs at 95 German hospitals were included in the study, of whom 1503 (12.6 %) were diagnosed with severe sepsis or septic shock. In 860 cases (57.2 %) the infections were of nosocomial origin. The point prevalence was 17.9 % (95 % CI 16.3–19.7).The calculated incidence rate of severe sepsis or septic shock was 11.64 (95 % CI 10.51–12.86) per 1000 ICU days. ICU mortality in patients with severe sepsis/septic shock was 34.3 %, compared with 6 % in those without sepsis. Total hospital mortality of patients with severe sepsis or septic shock was 40.4 %. Classification of the septic shock patients using the new SEPSIS-3 definitions showed higher ICU and hospital mortality (44.3 and 50.9 %).

Conclusions

Severe sepsis and septic shock continue to be a frequent syndrome associated with high hospital mortality. Nosocomial infections play a major role in the development of sepsis. This study presents a pragmatic, affordable and feasible method for the surveillance of sepsis epidemiology. Implementation of the new SEPSIS-3 definitions may have a major effect on future epidemiological data.

Keywords

References

  1. 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 publisher's website
    • View reference on PubMed
  2. Iwashyna TJEE, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304:1787–1794
    • View reference on publisher's website
    • View reference on PubMed
  3. Jawad I, Luksic I, Rafnsson SB (2012) Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health 2:010404
    • View reference on publisher's website
    • View reference on PubMed
  4. Andreu Ballester JC, Ballester F, Gonzalez Sanchez A, Almela Quilis A, Colomer Rubio E, Penarroja Otero C (2008) Epidemiology of sepsis in the Valencian Community (Spain), 1995–2004. Infect Control Hosp Epidemiol 29:630–634
    • View reference on publisher's website
    • View reference on PubMed
  5. Harrison DA, Welch CA, Eddleston JM (2006) The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care 10:R42
    • View reference on publisher's website
    • View reference on PubMed
  6. 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 publisher's website
    • View reference on PubMed
  7. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL (2007) Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med 35:1244–1250
    • View reference on publisher's website
    • View reference on PubMed
  8. Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, Jimenez E, Mohan A, Khan RA, Whittle J, Jacobs E, Nanchal R, Milwaukee Initiative in Critical Care Outcomes Research Group of Investigators (2011) Nationwide trends of severe sepsis in the 21st century (2000–2007). Chest 140:1223–1231
    • View reference on publisher's website
    • View reference on PubMed
  9. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R (2014) Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA 311:1308–1316
    • View reference on publisher's website
    • View reference on PubMed
  10. Rothberg MB, Pekow PS, Priya A, Lindenauer PK (2014) Variation in diagnostic coding of patients with pneumonia and its association with hospital risk-standardized mortality rates: a cross-sectional analysis. Ann Intern Med 160:380–388
    • View reference on publisher's website
    • View reference on PubMed
  11. Lindenauer PK, Lagu T, Shieh MS, Pekow PS, Rothberg MB (2012) Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003–2009. JAMA 307:1405–1413
    • View reference on publisher's website
    • View reference on PubMed
  12. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315:801–810
    • View reference on publisher's website
    • View reference on PubMed
  13. Engel C, Brunkhorst F, Bone H-G, Brunkhorst R, Gerlach H, Grond S, Gruendling M, Huhle G, Jaschinski U, John S, Mayer K, Oppert M, Olthoff D, Quintel M, Ragaller M, Rossaint R, Stuber F, Weiler N, Welte T, Bogatsch H et al (2007) Epidemiology of sepsis in Germany: results from a national prospective multicenter study. Intensive Care Med 33:606–618
  14. Committee ASCC (1992) Definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874
    • View reference on publisher's website
  15. Vincent J-L, Moreno R, Takala J, Willatts S, Mendonca AD, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710
  16. Freeman J, Hutchison GB (1980) Prevalence, incidence and duration. Am J Epidemiol 112:707–723
    • View reference on publisher's website
    • View reference on PubMed
  17. Weiss M, Huber-Lang M, Taenzer M, Kron M, Hay B, Nass M, Huber M, Schneider M (2010) How many variables need to be fulfilled when defining sepsis due to the 2003 SCCM/ESICM/ACCP/ATS/SIS definitions in critically ill surgical patients: a retrospective observational study. BMC Anesthesiol 10:22
    • View reference on publisher's website
    • View reference on PubMed
  18. Weiss M, Huber-Lang M, Taenzer M, Traeger K, Altherr J, Kron M, Hay B, Schneider M (2009) Different patient case mix by applying the 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions instead of the 1992 ACCP/SCCM sepsis definitions in surgical patients: a retrospective observational study. BMC Med Inform Decis Mak 9:25
    • View reference on publisher's website
    • View reference on PubMed
  19. Vincent J, Rello J, Marshall J et al (2009) International study of the prevalence and outcomes of infection in intensive care units. JAMA 302:2323–2329
    • View reference on publisher's website
    • View reference on PubMed
  20. Kollef MH, Zilberberg MD, Shorr AF, Vo L, Schein J, Micek ST, Kim M (2011) Epidemiology, microbiology and outcomes of healthcare-associated and community-acquired bacteremia: a multicenter cohort study. J Infect 62:130–135
    • View reference on publisher's website
    • View reference on PubMed
  21. Geffers C, Gastmeier P (2011) Nosocomial infections and multidrugresistant organisms in Germany epidemiological data from KISS (The Hospital Infection Surveillance System). Dtsch Arztebl Int 108:87–93
    • View reference on PubMed
  22. Heublein SHM, Hagel S, Hutagalung R, Brunkhorst FM (2013) Epidemiology of sepsis in German hospitals derived from administrative databases. Infection 41:41
    • View reference on publisher's website
  23. Levy MM, Artigas A, Phillips GS, Rhodes A, Beale R, Osborn T, Vincent JL, Townsend S, Lemeshow S, Dellinger RP (2012) Outcomes of the Surviving Sepsis Campaign in intensive care units in the USA and Europe: a prospective cohort study. Lancet Infect Dis 12:919–924
    • View reference on publisher's website
    • View reference on PubMed
  24. Beale RRK, Brunkhorst FM, Dobb G, Levy M, Martin G et al (2009) Promoting Global Research Excellence in Severe Sepsis (PROGRESS): lessons from an international sepsis registry. Infection 37:222–232
    • View reference on publisher's website
    • View reference on PubMed
  25. Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, Mira JP, Dequin PF, Gergaud S, Weiss N, Legay F, Le Tulzo Y, Conrad M, Robert R, Gonzalez F, Guitton C, Tamion F, Tonnelier JM, Guezennec P, Van Der Linden T, Vieillard-Baron A, Mariotte E, Pradel G, Lesieur O, Ricard JD, Herve F, du Cheyron D, Guerin C, Mercat A, Teboul JL, Radermacher P, Investigators S (2014) High versus low blood-pressure target in patients with septic shock. N Engl J Med 370:1583–1593
    • View reference on publisher's website
    • View reference on PubMed
  26. Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L (2014) Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 370:1412–1421
    • View reference on publisher's website
    • View reference on PubMed
  27. Gaieski DF, Edwards JM, Kallan MJ, Carr BG (2013) Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med 41:1167–1174
    • View reference on publisher's website
    • View reference on PubMed

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