Incidence, risk factors and impact on outcomes of secondary infection in patients with septic shock: an 8-year retrospective study

Guang-Ju Zhao,Xiao-Rong Chen,Dong Li,Jia-Xing Song,Qian Zhao,Meng-Fang Li,Guang-Liang Hong,Zhong-Qiu Lu,Bing Wu

doi:10.1038/srep38361

Abstract

Secondary infection in septic patients has received widespread attention, although clinical data are still lacking. The present study was performed on 476 patients with septic shock. Time trends for mortality were analyzed using Spearman’s rank correlation test. Risk factors for secondary infection were investigated by binary logistic regression. The extended Cox model with time-varying covariates and hazard ratios (HR) was performed to determine the impact of secondary infection on mortality. Differences in hospital length of stay (LOS) between patients with and without secondary infection were calculated using a multistate model. Thirty-nine percent of septic shock patients who survived the early phase of the disease developed secondary infection. There was a statistically significant increased odds ratio for secondary infection in older patients and patients with a longer LOS in the intensive care unit (ICU), a higher Sequential Organ Failure Assessment (SOFA) score, and endotracheal intubation. Secondary infection significantly reduced the rate of discharge (HR 5.607; CI95 3.612–8.704; P < 0.001) and was associated with an increased hospital LOS of 5.46 days. The present findings represent a direct description of secondary infection in septic shock patients and highlight the influence of this condition on septic shock outcomes.

Highlights

Secondary infection in septic patients has received widespread attention, clinical data are still lacking
Another retrospective study found that septic shock patients who died more than 3 days after intensive care unit (ICU) admission were related to ICU-acquired complications, including secondary infections[11]
Sepsis is an infection-induced systemic inflammatory response with an estimated mortality of 25%, which can reach up to 60% when shock is present13,14.numerous therapeutic strategies aimed at reducing mortality in these patients have been developed

Summary

Introduction

Secondary infection in septic patients has received widespread attention, clinical data are still lacking. Few retrospective studies have been designed to investigate the incidence and impact of secondary infection on clinical outcomes in septic patients. Otto et al.[10] demonstrated that the rates of common opportunistic bacteria and fungi increased significantly in the late phase (>1 5 days) of severe sepsis and septic shock when compared with the early phase (

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