Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study
Autoři:
Eric H. Chou aff001; Shaynna Mann aff001; Tzu-Chun Hsu aff003; Wan-Ting Hsu aff004; Carolyn Chia-Yu Liu aff005; Toral Bhakta aff002; Dahlia M. Hassani aff002; Chien-Chang Lee aff003
Působiště autorů:
Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, United States of America
aff001; Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, Texas, United States of America
aff002; Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
aff003; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
aff004; McTimoney College of Chiropractic, School of Health, BPP University, Abingdon, Oxfordshire, United Kingdom
aff005
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0227752
Souhrn
Purpose
To determine the trends of infection sites and outcome of sepsis using a national population-based database.
Materials and methods
Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality.
Results
During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%).
Conclusions
The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.
Klíčová slova:
Bacteremia – Bloodstream infections – Death rates – Fungal diseases – Genitourinary infections – Lower respiratory tract infections – Sepsis – Skin infections
Zdroje
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PLOS One
2020 Číslo 1
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