Incidence and Impact of Healthcare-associated Infections on Patients Primarily Admitted with Sepsis and Non-sepsis Diagnoses
Abhishek Chintamani, Bala Prakash, Babu K Abraham, Ramesh Venkataraman
Healthcare-associated infections, ICU-acquired infections, Organ dysfunction, Sepsis
Citation Information :
Chintamani A, Prakash B, Abraham BK, Venkataraman R. Incidence and Impact of Healthcare-associated Infections on Patients Primarily Admitted with Sepsis and Non-sepsis Diagnoses. Indian J Crit Care Med 2021; 25 (3):292-295.
Objectives: To compare the incidence of healthcare-associated infections (HAI) and their outcomes between patients admitted to the ICU with sepsis and those admitted with non-sepsis diagnoses. Materials and methods: We performed a single-center, prospective, observational study of ICU patients at a tertiary level medical-surgical unit from April 2018 to October 2018. All patients admitted to the ICU with a length of stay (LOS) > 48 hours were included. Baseline data including demographics, comorbidities, and severity of illness scores were collected. Index occurrence of HAI in all these patients was noted and data regarding organ support and patient outcomes were recorded. The incidence, complications, ICU LOS, and 30-day mortality of HAI were compared between the patients admitted to ICU originally with sepsis and non-sepsis diagnoses. Results: A total of 271 patients were evaluated in our study (N = 106 for the sepsis group and N = 165 for the non-sepsis group). No significant difference between the groups was found in the incidence of HAI (29.2% in sepsis group vs 24.4% in non-sepsis group; p = 0.07). Complications (acute kidney injury (AKI): 71 vs 45%; p = 0.01, shock: 81 vs 55%; p = 0.05, need for mechanical ventilation (MV): 30 vs 15%; p = 0.04) were more common in sepsis group compared to the non-sepsis group. The ICU LOS (12.2 ± 5.2 days vs 8.8 ± 2.05 days; p = 0.01) was significantly longer in the sepsis group. There was no significant difference in 30-day mortality between the groups (45 vs 25%; p = 0.07). Conclusion: The incidence of HAI seems to be similar between patients admitted with sepsis and non-sepsis diagnoses. However, patients admitted with sepsis develop higher rates of organ failure secondary to HAI and have a longer ICU LOS compared to patients admitted with non-sepsis diagnoses. The mortality rate of HAI did not differ between these two groups.
Vincent JL, Marshall JC, Namendys-Silva SA, François B, Martin-Loeches I, ICON Investigators, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med 2014;2(5):380–386. DOI: 10.1016/S2213-2600(14)70061-X.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29(7):1303–1310. DOI: 10.1097/00003246-200107000-00002.
Boomer JS, To K, Chang KC, Takasu O, Osborne DF, Walton AH, et al. Immunosuppression in patients who die of sepsis and multiple organ failure. JAMA 2011;306(23):2594–2605. DOI: 10.1001/jama.2011.1829.
Leentjens J, Kox M, van der Hoeven JG, Netea MG, Pickkers P. Immunotherapy for the adjunctive treatment of sepsis: from immunosuppression to immunostimulation. Time for a paradigm change? Am J Respir Crit Care Med 2013;187(12):1287–1293. DOI: 10.1164/rccm.201301-0036CP.
Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol 2013;13(12):862–874. DOI: 10.1038/nri3552.
Hutchins NA, Unsinger J, Hotchkiss RS, Ayala A. The new normal: immunomodulatory agents against sepsis immune suppression. Trends Mol Med 2014;20(4):224–233. DOI: 10.1016/j.molmed.2014. 01.002.
Zhao GJ, Li D, Zhao Q, Song JX, Chen XR, Hong GL, et al. Incidence, risk factors and impact on outcomes of secondary infection in patients with septic shock: an 8-year retrospective study. Sci Rep 2016;6:38361.
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.
Fartoukh M, Maitre B, Honoré S, Cerf C, Zahar JR, Brun-Buisson C. Diagnosing pneumonia during mechanical ventilation: the clinical pulmonary infection score revisited. Am J Respir Crit Care Med 2003;168(2):173–179. 10.1164/rccm.200212-1449OC.
Centres of disease control and prevention. http://www.cdc.gov/.
KDIGO clinical practice guideline for acute kidney injury. 2012;2(1). http://www.kidney-international.org.
Ylipalosaai P, Ala-Kokko TI, Laurila J, Ohtonen P, Syrjälä H. Intensive care acquired infection is an independent risk factor for hospital mortality: a prospective cohort study. Crit Care 2006;10(2):R66. DOI: 10.1186/cc4902.
Llitjos JF, Gassama A, Charpentier J, Lambert J, de Roquetaillade C, Cariou A, et al. Pulmonary infections prime the development of subsequent ICU-acquired pneumonia in septic shock. Ann Intensive Care 2019;9(1):39. DOI: 10.1186/s13613-019-0515-x.
Potgieter PD, Linton DM, Forder AA. Nosocomial infections in respiratory intensive care unit. Crit Care Med1987;15(5):495–498. DOI: 10.1097/00003246-198705000-00008.
van Vught LA, Klein Klouwenberg PM, Spitoni C, Scicluna BP, Wiewel MA, Horn J, et al. Incidence, risk factors, and attributable mortality of secondary infections in the intensive care unit after admission for sepsis. JAMA 2016;315(14):1469–1479. DOI: 10.1001/jama.2016.2691.