Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.

Eric H Chou,Shaynna Mann,Wan-Ting Hsu,Tzu-Chun Hsu,Dahlia M Hassani,Toral Bhakta,Carolyn Chia-Yu Liu,Chien-Chang Lee,Florian B Mayr

doi:10.1371/journal.pone.0227752

Abstract

To determine the trends of infection sites and outcome of sepsis using a national population-based database. Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality. During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%). The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.

Highlights

Being one of the most expensive conditions to treat and a leading cause of death, sepsis has become a major health problem [1, 2]
The anatomic site of infection does have a differential impact on the mortality of septic patients
Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients

Summary

Introduction

Being one of the most expensive conditions to treat and a leading cause of death, sepsis has become a major health problem [1, 2]. Sepsis was ranked in the top four most costly conditions, costing an aggregate of $20,298,000 million yearly, in US hospitals between all four payer groups (Medicare, Medicaid, private insurers, and uninsured) [4]. This burden on the healthcare system has led to researchers attempting to redefine sepsis and understand its pathophysiologic basis [5, 6]. A study directed towards investigating these issues is important for intensive care resource allocation, public health prevention, and helping prioritize future research

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