Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group

K. E. Sands, D. W. Bates, P. N. Lanken, P. S. Graman, P. L. Hibberd, K. L. Kahn, J. Parsonnet, R. Panzer, E. J. Orav and D. R. Snydman
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, USA. ksands@bidmc.harvard.edu

CONTEXT: Sepsis syndrome is a leading cause of mortality in hospitalized patients. However, few studies have described the epidemiology of sepsis syndrome in a hospitalwide population. OBJECTIVE: To describe the epidemiology of sepsis syndrome in the tertiary care hospital setting. DESIGN: Prospective, multi-institutional, observational study including 5-month follow-up. SETTING: Eight academic tertiary care centers. METHODS: Each center monitored a weighted random sample of intensive care unit (ICU) patients, non-ICU patients who had blood cultures drawn, and all patients who received a novel therapeutic agent or who died in an emergency department or ICU. Sepsis syndrome was defined as the presence of either a positive blood culture or the combination of fever, tachypnea, tachycardia, clinically suspected infection, and any 1 of 7 confirmatory criteria. Estimates of total cases expected annually were extrapolated from the number of cases, the period of observation, and the sampling fraction. RESULTS: From January 4, 1993, to April 2, 1994, 12759 patients were monitored and 1342 episodes of sepsis syndrome were documented. The extrapolated, weighted estimate of hospitalwide incidence (mean+/-95% confidence limit) of sepsis syndrome was 2.0+/-0.16 cases per 100 admissions, or 2.8+/-0.17 per 1000 patient-days. The unadjusted attack rate for sepsis syndrome between individual centers differed by as much as 3-fold, but after adjustment for institutional differences in organ transplant populations, variation from the expected number of cases was reduced to 2-fold and was not statistically significant overall. Patients in ICUs accounted for 59% of total extrapolated cases, non-ICU patients with positive blood cultures for 11%, and non-ICU patients with negative blood cultures for 30%. Septic shock was present at onset of sepsis syndrome in 25% of patients. Bloodstream infection was documented in 28%, with gram-positive organisms being the most frequent isolates. Mortality was 34% at 28 days and 45% at 5 months. CONCLUSIONS: Sepsis syndrome is common in academic hospitals, although the overall rates vary considerably with the patient population. A substantial fraction of cases occur outside ICUs. An understanding of the hospitalwide epidemiology of sepsis syndrome is vital for rational planning and treatment of hospitalized patients with sepsis syndrome, especially as new and expensive therapeutic agents become available.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Sesame Oil Does Not Show Accumulatively Enhanced Protection Against Oxidative Stress-Associated Hepatic Injury in Septic Rats
Hsu et al.
JPEN J Parenter Enteral Nutr 2008;32:276-280.
ABSTRACT | FULL TEXT  

Sesame Oil Attenuates Hepatic Lipid Peroxidation by Inhibiting Nitric Oxide and Superoxide Anion Generation in Septic Rats
Hsu et al.
JPEN J Parenter Enteral Nutr 2008;32:154-159.
ABSTRACT | FULL TEXT  

Simulated Joint Infection Assessment by Rapid Detection of Live Bacteria with Real-Time Reverse Transcription Polymerase Chain Reaction
Birmingham et al.
JBJS 2008;90:602-608.
ABSTRACT | FULL TEXT  

Racial Variation in the Incidence, Care, and Outcomes of Severe Sepsis: Analysis of Population, Patient, and Hospital Characteristics
Barnato et al.
Am. J. Respir. Crit. Care Med. 2008;177:279-284.
ABSTRACT | FULL TEXT  

Postoperative Care of Cardiac Surgery Patients
Khalpey et al.
Card Surg Adult 2008;3:465-486.
FULL TEXT  

C1 Inhibitor-Mediated Protection from Sepsis
Liu et al.
J. Immunol. 2007;179:3966-3972.
ABSTRACT | FULL TEXT  

Chronic Sepsis Mortality Characterized by an Individualized Inflammatory Response
Osuchowski et al.
J. Immunol. 2007;179:623-630.
ABSTRACT | FULL TEXT  

Arginine vasopressin inhibits Kir6.1/SUR2B channel and constricts the mesenteric artery via V1a receptor and protein kinase C
Shi et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 2007;293:R191-R199.
ABSTRACT | FULL TEXT  

Cellular Mechanisms in Sepsis
Jean-Baptiste
J Intensive Care Med 2007;22:63-72.
ABSTRACT  

Posterior Reversible Encephalopathy Syndrome in Infection, Sepsis, and Shock
Bartynski et al.
Am. J. Neuroradiol. 2006;27:2179-2190.
ABSTRACT | FULL TEXT  

Systemic NO production during (septic) shock depends on parenchymal and not on hematopoietic cells: in vivo iNOS expression pattern in (septic) shock
Bultinck et al.
FASEB J. 2006;20:2363-2365.
ABSTRACT | FULL TEXT  

Histochemical evidence for lipid A (endotoxin) in eukaryote chloroplasts
Armstrong et al.
FASEB J. 2006;20:2145-2146.
ABSTRACT | FULL TEXT  

Obesity and sepsis.
Vachharajani and Vital
J Intensive Care Med 2006;21:287-295.
ABSTRACT  

Circulating Cytokine/Inhibitor Profiles Reshape the Understanding of the SIRS/CARS Continuum in Sepsis and Predict Mortality
Osuchowski et al.
J. Immunol. 2006;177:1967-1974.
ABSTRACT | FULL TEXT  

The Epidemiology of Sepsis in Patients With Malignancy
Danai et al.
Chest 2006;129:1432-1440.
ABSTRACT | FULL TEXT  

Parvovirus B19 Presenting with Severe Sepsis in a Previously Healthy 25-year-old Female.
Bailey
J Am Board Fam Med 2006;19:317-319.
FULL TEXT  

Immunologic responses to critical injury and sepsis.
Smith et al.
J Intensive Care Med 2006;21:160-172.
ABSTRACT  

Severe sepsis in community-acquired pneumonia: when does it happen, and do systemic inflammatory response syndrome criteria help predict course?
Dremsizov et al.
Chest 2006;129:968-978.
ABSTRACT | FULL TEXT  

Risk stratification of severe sepsis patients in the emergency department.
Chen et al.
Emerg. Med. J. 2006;23:281-285.
ABSTRACT | FULL TEXT  

Evaluating the clinical and financial impact of severe sepsis with Medicare or other administrative hospital data
Ernst et al.
Am J Health Syst Pharm 2006;63:575-581.
FULL TEXT  

The Last 100 Years of Sepsis
Vincent and Abraham
Am. J. Respir. Crit. Care Med. 2006;173:256-263.
ABSTRACT | FULL TEXT  

Gastrin-releasing Peptide Receptor Antagonist Effects on an Animal Model of Sepsis
Dal-Pizzol et al.
Am. J. Respir. Crit. Care Med. 2006;173:84-90.
ABSTRACT | FULL TEXT  

Drotrecogin alfa (activated) for adults with severe sepsis and a low risk of death.
Abraham et al.
NEJM 2005;353:1332-1341.
ABSTRACT | FULL TEXT  

Incidence and Impact of Organ Dysfunctions Associated With Sepsis
Guidet et al.
Chest 2005;127:942-951.
ABSTRACT | FULL TEXT  

Sepsis and the Role of Activated Protein C
Tazbir
Crit Care Nurse 2004;24:40-45.
FULL TEXT  

Adrenergic modulation of splenic macrophage cytokine release in polymicrobial sepsis
Deng et al.
Am. J. Physiol. Cell Physiol. 2004;287:C730-C736.
ABSTRACT | FULL TEXT  

Increased iNOS activity is essential for pulmonary epithelial tight junction dysfunction in endotoxemic mice
Han et al.
Am. J. Physiol. Lung Cell. Mol. Physiol. 2004;286:L259-L267.
ABSTRACT | FULL TEXT  

Current Epidemiology of Septic Shock: The CUB-Rea Network
Annane et al.
Am. J. Respir. Crit. Care Med. 2003;168:165-172.
ABSTRACT | FULL TEXT  

Advances in Treating Patients With Severe Sepsis: Role of Drotrecogin Alfa (Activated)
Kleinpell
Crit Care Nurse 2003;23:16-29.
FULL TEXT  

The Epidemiology of Sepsis in the United States from 1979 through 2000
Martin et al.
NEJM 2003;348:1546-1554.
ABSTRACT | FULL TEXT  

Meeting Unmet Needs in Patients With Sepsis: the Role of Drotrecogin Alfa (Activated)
Morris
Am J Crit Care 2003;12:94-97.
FULL TEXT  

The Epidemiology of Severe Sepsis in Children in the United States
Watson et al.
Am. J. Respir. Crit. Care Med. 2003;167:695-701.
ABSTRACT | FULL TEXT  

Drotrecogin alfa (activated): a novel therapeutic strategy for severe sepsis
Pastores
Postgrad. Med. J. 2003;79:5-10.
ABSTRACT | FULL TEXT  

Epidemiology and Prognostic Determinants of Bloodstream Infections in Surgical Intensive Care
Harbarth et al.
Arch Surg 2002;137:1353-1359.
ABSTRACT | FULL TEXT  

Lipopolysaccharide Rapidly Traffics to and from the Golgi Apparatus with the Toll-like Receptor 4-MD-2-CD14 Complex in a Process That Is Distinct from the Initiation of Signal Transduction
Latz et al.
J. Biol. Chem. 2002;277:47834-47843.
ABSTRACT | FULL TEXT  

Bacterial Peptidoglycan-associated Lipoprotein Is Released into the Bloodstream in Gram-negative Sepsis and Causes Inflammation and Death in Mice
Hellman et al.
J. Biol. Chem. 2002;277:14274-14280.
ABSTRACT | FULL TEXT  

Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
Rivers et al.
NEJM 2001;345:1368-1377.
ABSTRACT | FULL TEXT  

Molecular Genetic Analysis of an Endotoxin Nonresponder Mutant Cell Line: A Point Mutation in a Conserved Region of MD-2 Abolishes Endotoxin-induced Signaling
Schromm et al.
J. Exp. Med. 2001;194:79-88.
ABSTRACT | FULL TEXT  

Long-term-impaired expression of nuclear factor-{kappa}B and I{kappa}B{alpha} in peripheral blood mononuclear cells of trauma patients
Adib-Conquy et al.
J. Leukoc. Biol. 2001;70:30-38.
ABSTRACT | FULL TEXT  

E5 Murine Monoclonal Antiendotoxin Antibody in Gram-Negative Sepsis: A Randomized Controlled Trial
Angus et al.
JAMA 2000;283:1723-1730.
ABSTRACT | FULL TEXT  

Protection from Lethal Gram-positive Infection by Macrophage Scavenger Receptor-dependent Phagocytosis
Thomas et al.
J. Exp. Med. 2000;191:147-156.
ABSTRACT | FULL TEXT  

The Clinical Host Response to Microbial Infection in Medical Patients With Fever
Bossink et al.
Chest 1999;116:380-390.
ABSTRACT | FULL TEXT  

Clindamycin Suppresses Endotoxin Released by Ceftazidime-Treated Escherichia coli O55:B5 and Subsequent Production of Tumor Necrosis Factor Alpha and Interleukin-1beta
Kishi et al.
Antimicrob. Agents Chemother. 1999;43:616-622.
ABSTRACT | FULL TEXT