Abstract
BackgroundSecondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis.MethodsA four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively.ResultsA total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90.ConclusionsUrinary and deep venous catheterization increased the risk of secondary infection, in which underlying immunosuppression might also play a role. Secondary infection affected the prognosis of septic patients and prolonged in-hospital length of stay.
Highlights
Secondary infection has a higher incidence in septic patients and affects clinical outcomes
Some studies focused on the association between secondary infection and the prognosis of septic patients but the results were inconsistent in how secondary infection influenced the prognosis and whether it was the major cause of death [5, 6]
A recent meta-analysis revealed that lower respiratory tract was the most common site of nosocomial infection in general hospital and Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii and Klebsiella pneumoniae were among most common pathogens [27]
Summary
Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis. Some other patients developed secondary infection which led to the aggravation of disease and even the multiple organ dysfunction syndrome (MODS). Previous studies have provided some findings on the risk factors of developing secondary infection, such as age, severity of primary disease, length of stay (LOS) in ICU and invasive procedures [3, 4]. Some studies focused on the association between secondary infection and the prognosis of septic patients but the results were inconsistent in how secondary infection influenced the prognosis and whether it was the major cause of death [5, 6]
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