Abstract
Background: The main aim of the study was to analyse characteristics of sepsis according to the setting of occurrence and to identify predictors of sepsis-related in-hospital mortality. Methods: 544 medical records of adult patients with a diagnosis of sepsis were consulted and divided into two groups according to the setting where sepsis originated: community-acquired (CA) and healthcare-associated (HA) sepsis. Results: Overall, 257 (47.2%) patients had HA sepsis and the in-hospital death rate was 33.6%. Results of the multiple logistic regression revealed that patients with HA sepsis were significantly more likely to have been admitted from another hospital or ward, to have a ≥1 Charlson’s index, to be immunesuppressed, and to have undergone a surgical intervention during hospitalization. In-hospital deaths were significantly associated with older age, admission from another hospital or ward, need of haemodialysis and mechanical ventilation (MV), whereas they were less likely in patients with HA sepsis as compared with CA sepsis. Conclusion: Community-acquired and HA sepsis show distinct clinical, prognostic and risk factors profiles, and should be managed according to their differential characteristics.
Highlights
Recognition of sepsis is far from straightforward, due to the vague and non-specific presentation in the early stages and to the extremely variable clinical characteristics; the identification of markers for early detection that predict the development of sepsis and associated mortality is still challenging, since sepsis outcomes are largely dependent from prompt and effective management through control of underlying infection, support of organs dysfunctions, and resuscitation
It has been reported that it may be misleading to consider these entities as a whole group, since they may be very dissimilar as regards to several characteristics such as aetiology, risk factors, underlying infection, patients’ characteristics, onset, and prognosis [4]; one of the challenges in the description of the burden and mortality related to sepsis is the opportunity to separately consider these diverse clinical entities
The overall picture describing patients with sepsis shows a high frequency of frail subjects affected by one or more comorbidities or immune suppressed, a wide range of primary sites of infection as well as a high number of unrecognized primary sites of infection, whereas most of the isolated micro-organisms are those encountered in healthcare-associated infections (HAIs), such as Staphylococcus spp., Candida spp., Klebsiella spp., and Acinetobacter spp
Summary
It is well known that sepsis, recently defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection [1], remains an unresolved and challenging public health issue and, its true incidence and mortality are difficult to calculate, it is one of the leading causes of death globally.Researchers and clinicians have long debated on the need to improve prevention, early detection, and clinical management of sepsis, and in 2017 the World Health Assembly and WHO have strongly focused attention on several sepsis-related issues and have declared sepsis a global health priority [2].Recognition of sepsis is far from straightforward, due to the vague and non-specific presentation in the early stages and to the extremely variable clinical characteristics; the identification of markers for early detection that predict the development of sepsis and associated mortality is still challenging, since sepsis outcomes are largely dependent from prompt and effective management through control of underlying infection, support of organs dysfunctions, and resuscitation.Several patients’ characteristics are associated with a higher risk of developing sepsis; elderly patients, affected by severe comorbidities, such as cancer or renal failure, as well as by impaired immunity, including stressors such as surgery, trauma or burns have been found to have a significantly higher risk of developing sepsis [3].Antibiotics 2020, 9, 263; doi:10.3390/antibiotics9050263 www.mdpi.com/journal/antibioticsRecently, patients with sepsis have been classified in clinically distinguished subgroups according to the setting where sepsis originated: (1) patients admitted with a “community-acquired” (CA) sepsis;(2) those who develop sepsis few days after admission and recognize one or more “healthcare-associated”risk factors prior to admission; and (3) those who are diagnosed a “hospital-acquired” sepsis during hospital stay. Recognition of sepsis is far from straightforward, due to the vague and non-specific presentation in the early stages and to the extremely variable clinical characteristics; the identification of markers for early detection that predict the development of sepsis and associated mortality is still challenging, since sepsis outcomes are largely dependent from prompt and effective management through control of underlying infection, support of organs dysfunctions, and resuscitation. It has been reported that it may be misleading to consider these entities as a whole group, since they may be very dissimilar as regards to several characteristics such as aetiology, risk factors, underlying infection, patients’ characteristics, onset, and prognosis [4]; one of the challenges in the description of the burden and mortality related to sepsis is the opportunity to separately consider these diverse clinical entities. The main aim of the study was to analyse characteristics of sepsis according to the setting of occurrence and to identify predictors of sepsis-related in-hospital mortality
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