Aetiology, antimicrobial therapy and outcome of patients with community acquired severe sepsis: a prospective study in a Norwegian university hospital

BMC Infectious Diseases

Steinar Skrede⁴  Oddbjørn Haugen²  Rune Fanebust¹  Hans K Flaatten²  Nina Langeland⁴  Siri Tandberg Nygård³ 

[1] Department of Heart Diseases, Haukeland University Hospital, Bergen, Norway;Department of Clinical Medicine, University of Bergen, Bergen, Norway;Department of Clinical Science, University of Bergen, Bergen, Norway;Department of Medicine, Haukeland University Hospital, Jonas Lies vei 63, Bergen N 5021, Norway

关键词: Outcome;    Compliance;    Antimicrobial therapy;    Aetiology;    Epidemiology;    Severe sepsis;   

Others  :  1134438
DOI  :  10.1186/1471-2334-14-121

 received in 2013-07-17, accepted in 2014-02-21,  发布年份 2014

【 摘 要 】

Background

Severe sepsis is recognized as an inflammatory response causing organ dysfunction in patients with infection. Antimicrobial therapy is the mainstay of treatment. There is an ongoing demand for local surveillance of sepsis aetiology and monitoring of empirical treatment recommendations. The present study was established to describe the characteristics, quality of handling and outcome of patients with severe sepsis admitted to a Norwegian university hospital.

Methods

A one year prospective, observational study of adult community acquired case-defined severe sepsis was undertaken. Demographics, focus of infection, microbiological findings, timing and adequacy of empirical antimicrobial agents were recorded. Clinical diagnostic practice was evaluated. Differences between categorical groups were analysed with Pearson’s chi-squared test. Predictors of in-hospital mortality were identified in a multivariate stepwise backward logistic regression model.

Results

In total 220 patients were identified, yielding an estimated annual incidence of 0.5/1000 inhabitants. The focus of infection was established at admission in 69%. Respiratory tract infection was present in 52%, while genitourinary, soft tissue and abdominal infections each were found in 12-14%. Microbiological aetiology was identified in 61%; most prevalent were Streptococcus pneumoniae, Escherichia coli and Staphylococcus aureus. Independent predictors of in-hospital mortality were malignancy, cardiovascular disease, endocarditis, abdominal infections, undefined microbiological aetiology, delay in administration of empirical antimicrobial agents ≥ 6 hours and use of inadequate antimicrobial agents. In patients ≥ 75 years, antimicrobial therapy was less in compliance with current recommendations and more delayed.

Conclusions

Community acquired severe sepsis is common. Initial clinical aetiology is often revised. Compliance with recommendations for empirical antimicrobial treatment is lowest in elderly patients. Our results emphasizes that quick identification of correct source of infection, proper sampling for microbiological analyses, and fast administration of adequate antimicrobial agents are crucial points in the management of severe sepsis.

【 授权许可】

   
2014 Nygård et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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