Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis

Abstract

Purpose: Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospitalacquired (HA) and ICU-acquired (ICU-A) sepsis. Methods: We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed. Results: Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low-and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies.

Inzidenz der Sepsis in Deutschland und weltweit

“…Der Anteil von nosokomialer Sepsis unter allen Sepsisfällen wird in einer aktuellen Metaanalyse auf 23,6 % (95 %-KI 17–31,8 %) geschätzt [ 19 ]. In 24,4 % (95 %-KI 16,7–34,2 %, „range“ 10,3–42,5 %) der auf Intensivstation behandelten Fälle wird die Sepsis als auf der Intensivstation erworben erachtet, in 48,7 % als im Krankenhaus erworben.…”

How to ventilate obstructive and asthmatic patients

“…In addition, in most low- and middle-income countries, ICUs are scarce, and resources are limited. The availability of invasive mechanical ventilation, in particular, is limited, and its use is associated with a high risk of mortality, especially from ventilator-associated pneumonia [ 73 – 75 ]. As in high-income countries, NIV should be preferred to invasive ventilation, particularly in cases of COPD exacerbation.…”

Identification of Potential Early Diagnostic Biomarkers of Sepsis

“… 5 The incidence of sepsis varies considerably among different geographical regions. 6 Different aspects of society, economy, politics, health, and even climate affect the epidemiology of sepsis. 7 Community infections account for approximately 60–70% of all cases; nosocomial infections outside the ICU, 20–30%; and primary cases in the ICU, 5–9%.…”