Incidence of severe sepsis and septic shock in German intensive care units: the prospective, multicentre INSEP study.

Abstract

To estimate the incidence density, point prevalence and outcome of severe sepsis and septic shock in German intensive care units (ICUs). 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. 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%). 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.