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.
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Change history
01 December 2017
The members of the SepNet Critical Care Trials Group were provided in such a way that they could not be indexed as collaborators on PubMed. The publisher apologizes for this error and is pleased to list the members of the group here:
References
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
Iwashyna TJEE, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304:1787–1794
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
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
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
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
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
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
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
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
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
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
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
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
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
Freeman J, Hutchison GB (1980) Prevalence, incidence and duration. Am J Epidemiol 112:707–723
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
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
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
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
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
Heublein SHM, Hagel S, Hutagalung R, Brunkhorst FM (2013) Epidemiology of sepsis in German hospitals derived from administrative databases. Infection 41:41
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
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
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
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
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
Acknowledgements
Writing Committee: Gernot Marx, Melanie Schäfer, Josef Briegel, Tobias Schuerholz, Stefan Schröder, Friedhelm Bach, Ulrich Jaschinski, Manfred Weiß, Stefan Kluge, Holger Bogatsch, Frank Bloos, Norbert Weiler, and Michael Oppert.
Study design and protocol: Gernot Marx, Frank Bloos, Josef Briegel, Herwig Gerlach, Matthias Gründling, Axel Nierhaus, Michael Oppert, Konrad Reinhart, Rolf Rossaint, Michael Quintel, Norbert Weiler, Manfred Weiß, and Christoph Engel.
Statistical Analysis: Holger Bogatsch performed the full statistical analysis.
Database: Matthias Loebe.
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A full list of SepNet Critical Care Trials Group (SepNet) authors and investigators is presented in the supplementary material (ESM2).
A correction to this article is available online at https://doi.org/10.1007/s00134-017-4980-0.
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SepNet Critical Care Trials Group. Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study. Intensive Care Med 42, 1980–1989 (2016). https://doi.org/10.1007/s00134-016-4504-3
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DOI: https://doi.org/10.1007/s00134-016-4504-3