Epidemiology of Sepsis Syndrome among Intensive Care Unit Patients at a Tertiary University Hospital in Palestine in 2019
Hadi A Rabee, Raghad Tanbour, Zaher Nazzal, Yousef Hamshari, Yousef Habash, Ahmad Anaya, Abbas Iter, Mohammad Gharbeyah, Dina Abugaber
Epidemiology, Intensive care unit, Palestine, Sepsis syndrome
Citation Information :
Rabee HA, Tanbour R, Nazzal Z, Hamshari Y, Habash Y, Anaya A, Iter A, Gharbeyah M, Abugaber D. Epidemiology of Sepsis Syndrome among Intensive Care Unit Patients at a Tertiary University Hospital in Palestine in 2019. Indian J Crit Care Med 2020; 24 (7):551-556.
Background: Sepsis syndrome is an emerging healthcare problem, especially in critically ill patients, regardless whether it\'s community- or hospital-acquired sepsis. This study evaluates the characteristics of these patients, in addition to the type, source, and outcome of sepsis and septic shock, in a university tertiary hospital in Palestine. It also studies the most common organisms encountered in these patients. Materials and methods: This is retrospective observational chart review study of all adult admissions to the intensive care unit over a period of 2 years. The presence of sepsis and septic shock was assessed and documented based on the Third International Consensus Definitions (Sepsis-3). Data regarding demographics, severity, comorbidities, source of infection, microbiology, length of stay, and outcomes (dead/alive at discharge from ICU) were recorded. Results: A total number of 174 patients were included. The mean age was 57.4 years, with cardiovascular diseases and diabetes being the leading comorbidities encountered in them. Respiratory infections were the most common site of sepsis, found in around 71% of patients, followed by urinary tract infections. More than 70% of cases were due to hospital-acquired infections (HAIs). Acinetobacter species were the most common gram-negative organisms encountered, while Enterococcus was the most common gram-positive organisms. Around 54% of patients had multidrug-resistant organisms. The average length of stay in the ICU was 8 days. The average mortality rate was 39.7%, which is higher among septic shock patients. Conclusion: Both sepsis and septic shock carry high morbidity and mortality rates, and they are very frequent among critically ill patients. Special care and developing management bundles are crucial in controlling and preventing this threat.
Esteban A, Frutos-Vivar F, Ferguson ND, Peñuelas O, Lorente JÁ, Gordo F, et al. Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med 2007;35(5):1284–1289. DOI: 10.1097/01.CCM.0000260960.94300.DE.
Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the global burden of disease study 2015. Lancet 2016;388(10053):1459–1544. DOI: 10.1016/S0140-6736(16)31012-1.
Rudd KE, Kissoon N, Limmathurotsakul D, Bory S, Mutahunga B, Seymour CW, et al. The global burden of sepsis: Barriers and potential solutions. Crit Care 2018;22(1):123305059. DOI: 10.1186/s13054-018-2157-z.
Lagu T, Rothberg MB, Shieh M-S, Pekow PS, Steingrub JS, Lindenauer PK. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med 2012;40(3):754–761. DOI: 10.1097/CCM.0b013e318232db65.
Baharoon S, Telmesani A, Tamim H, Alsafi E, Aljohani S, Mahmoud E, et al. Community- versus nosocomial-acquired severe sepsis and septic shock in patients admitted to a tertiary intensive care in Saudi Arabia, etiology and outcome. J Infect Public Health 2015;8(5): 418–424. DOI: https://doi.org/10.1016/j.jiph.2014.12.003.
Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S, et al. Epidemiology and outcome of sepsis syndromes in Italian ICUs: a muticentre, observational cohort study in the region of piedmont. Minerva Anestesiol 2013;79(9):993–1002.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The acCp/scCm consensus conference Committee. American college of chest physicians/society of critical care edicine. Chest 1992;101(6):1644–1655. DOI: 10.1378/chest.101.6.1644.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Crit Care Med 2018;46(6):997–1000. DOI: 10.1097/CCM.0000000000003119.
Cardoso T, Carneiro AH, Ribeiro O, Teixeira-Pinto A, Costa-Pereira A. Reducing mortality in severe sepsis with the implementation of a core 6-hour bundle: results from the Portuguese community-acquired sepsis study (SACiUCI study). Crit Care 2010(3):14. DOI: 10.1186/cc9008.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268–281. DOI: 10.1111/j.1469-0691.2011.03570.x.
Dabar G, Harmouche C, Salameh P, Jaber BL, Jamaleddine G, Waked M, et al. Community- and healthcare-associated infections in critically ill patients: a multicenter cohort study. Int J Infect Dis 2015;37:80–85. DOI: 10.1016/j.ijid.2015.05.024.
Baykara N, Akalin H, Arslantas MK, Hanci V, Caglayan C, Kahveci F, et al. Epidemiology of sepsis in Turkish intensive care units: a multicenter point-prevalence study. Crit Care 2017;21:1–14. DOI: 10.1186/s13054-017-1629-x.
Vincent J-L, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in european intensive care units: results of the SOAP study. Crit Care Med 2006;34(2):344–353. DOI: 10.1097/01.ccm.0000194725.48928.3a.
Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med 2004;30(4):589–596. DOI: 10.1007/s00134-004-2157-0.
Ott E, Saathoff S, Graf K, Schwab F, Chaberny IF. The prevalence of nosocomial and community acquired infections in a university hospital: an observational study. Dtsch Arztebl Int 2013; 110(31-32):533–540. DOI: 10.3238/arztebl.2013.0533.
Sadaka F, EthmaneAbouElMaali C, Cytron MA, Fowler K, Javaux VM, O'Brien J. Predicting mortality of patients with sepsis: a comparison of APACHE II and APACHE III scoring systems. J Clin Med Res 2017;9(11):907–910. DOI: 10.14740/jocmr3083w.
Machado F, Cavalcanti A, Bozza F, Angus D, Ferreira E, Carrara F, et al. Epidemiology of sepsis in Brazilian icus: a nationwide stratified sample. Intensive Care Med Exp 2015;3(S1):3–4. DOI: 10.1186/2197-425x-3-s1-a642.
Todi S, Chatterjee S, Sahu S, Bhattacharyya M. Epidemiology of severe sepsis in India: an update. Crit Care 2010;14(Suppl 1):P382–P382. DOI: 10.1186/cc8614.
Lin L, Jia L, Fu Y, Zhao R, Huang Y, Tang C, et al. A comparative analysis of infection in patients with malignant cancer: a clinical pharmacist consultation study. J Infect Public Health 2019;12(6):789–793. DOI: 10.1016/j.jiph.2019.03.021.