Does Infection Site Matter? A Systematic Review of Infection Site Mortality in Sepsis

Motzkus, Christine; Luckmann, Roger

doi:10.1177/0885066615627778

Cited by 30 publications

(34 citation statements)

References 34 publications

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“…They had prolonged organ dysfunction and the worst 12-month survival with notably poor functional outcomes. Previous studies looking at the role site of infection in outcomes after sepsis principally focused on hospital mortality [12][13][14][15]33]. From these reports, it can be concluded that site of infection does have an independent effect on hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the low 30-day mortalities observed in this study (ranging 14% in abdominal to 2% in S/ST), the relative differences by site are consistent with hospital mortalities from the previous published reports. A systematic review of studies from 2001 to 2014 found that pulmonary infections had the worst in hospital mortality [13]. When pulmonary infections were used as the reference, GU and S/ST infections had substantially lower mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, innumerable trials of promising immune-modulating interventions have failed to reduce early mortality and the recent consensus is that heterogeneity played a major role in these dismal failures [8][9][10]. It has been shown that site of infection is an independent predictor of early mortality [11][12][13][14][15]. However, the epidemiology of sepsis has evolved.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

et al. 2020

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Background: The role of site of infection in sepsis has been poorly characterized. Additionally, sepsis epidemiology has evolved. Early mortality has decreased, but many survivors now progress into chronic critical illness (CCI). This study sought to determine if there were significant differences in the host response and current epidemiology of surgical sepsis categorized by site of infection.Study design: This is a longitudinal study of surgical sepsis patients characterized by baseline predisposition, insult characteristics, serial biomarkers, hospital outcomes, and long-term outcomes. Patients were categorized into five anatomic sites of infection. Results:The 316 study patients were predominantly Caucasian; half were male, with a mean age of 62 years, high comorbidity burden, and low 30-day mortality (10%). The primary sites were abdominal (44%), pulmonary (19%), skin/soft tissue (S/ST, 17%), genitourinary (GU, 12%), and vascular (7%). Most abdominal infections were present on admission and required source control. Comparatively, they had more prolonged proinflammation, immunosuppression, and persistent organ dysfunction. Their long-term outcome was poor with 37% CCI (defined as > 14 in ICU with organ dysfunction), 49% poor discharge dispositions, and 30% 1-year mortality. Most pulmonary infections were hospitalacquired pneumonia. They had similar protracted proinflammation and organ dysfunction, but immunosuppression normalized. Long-term outcomes are similarly poor (54% CCI, 47% poor disposition, 32% 1-year mortality). S/ST and GU infections occurred in younger patients with fewer comorbidities, less perturbed immune responses, and faster resolution of organ dysfunction. Comparatively, S/ST had better long-term outcomes (23% CCI, 39% poor disposition, 13% 1-year mortality) and GU had the best (10% CCI, 20% poor disposition, 10% 1-year mortality). Vascular sepsis patients were older males, with more comorbidities. Proinflammation was blunted with baseline immunosuppression and organ dysfunction that persisted. They had the worst long-term outcomes (38% CCI, 67% poor disposition, 57% 1-year mortality). Conclusion: There are notable differences in baseline predisposition, host responses, and clinical outcomes by site of infection in surgical sepsis. While previous studies have focused on differences in hospital mortality, this study provides unique insights into the host response and long-term outcomes associated with different sites of infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

et al. 2020

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“…Therefore, it's probable that the anatomic infection site may have a significant impact on sepsis mortality. However, there has been a paucity of studies with inconsistent results addressing the various infectious sites effects on mortality, and no reports on the temporal trends of infectious sites and their outcomes [9][10][11][12]. Another aspect that could be influenced by studying current trends of infectious sites and their outcome could be researching specific preventative measures tailored towards the most common or highest risk infectious site.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Prior research has indicated that having positive cultures from certain culture sites could be correlated with worse long-term outcomes in patient with sepsis. 29 Therefore, we evaluated the culture site-specific impacts on 1-year survival in this study. We found that 1-year mortality was highly associated with positive cultures from blood, respiratory tract, or urinary tract, slightly associated with positive cultures from the skin and soft tissue, but not associated with positive cultures from the abdomen.…”

Section: Discussionmentioning

confidence: 99%

Association Between Positive Cultures During Admission and 1-Year Mortality in Patients With Cancer Receiving Perioperative Intensive Care

Chiang

Hsu

et al. 2018

Cancer Control

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The number of patients with cancer being admitted to intensive care units (ICUs) is increasing worldwide, and these patients are vulnerable to infection. This study aimed to address the long-term impact of positive cultures during admission on 1-year mortality among patients with cancer who received perioperative intensive care. This retrospective cohort study enrolled adult patients with cancer who were admitted to ICUs and received surgery during 2011 to 2016 at a tertiary hospital in central Taiwan. Cancer-related data were retrieved from the cancer registry, and data during ICU admissions were obtained from the electronic medical records. We compared the survival curves between patients with and without positive clinical cultures using log-rank test and used a multivariable Cox proportional hazards regression model to evaluate the influence of positive clinical cultures on 1-year mortality. A total of 638 patients were included for analyses, and 37.9% of them had positive cultures during the index admission. In-hospital mortality was 9.1%, while 1-year mortality was 21.0%. Compared with patients who survived, patients who died were significantly more likely to have positive cultures (59.7% vs 32.1%), to have a higher Acute Physiology and Chronic Health Evaluation II scores (median 21.8 vs 19.0), and to receive mechanical ventilation (86.6% vs 77.4%). Survival analysis found that positive cultures of blood, the respiratory tract, the urinary tract, or the skin and soft tissue were associated with an increased 1-year mortality. Multivariable Cox proportional hazards regression analysis found that positive cultures of blood, the respiratory tract, the urinary tract, or the skin and soft tissue (hazard ratio: 1.621; 95% confidence interval: 1.087-2.419) were significantly associated with 62.1% increased hazards of death within 1 year after the ICU admission. A positive culture during admission was associated with a worsened long-term survival among patients with cancer who received perioperative intensive care. Further studies are needed to confirm this association.

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Does Infection Site Matter? A Systematic Review of Infection Site Mortality in Sepsis

Abstract: Based on studies included in this review, the impact of infection site in patients with sepsis on hospital mortality could not be reliably estimated. Misclassification among infections and disease states remains a serious possibility in studies on this topic.

Cited by 30 publications

References 34 publications

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

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

Association Between Positive Cultures During Admission and 1-Year Mortality in Patients With Cancer Receiving Perioperative Intensive Care

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