Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.
Eric H Chou, Shaynna Mann, Tzu-Chun Hsu, Wan-Ting Hsu, Carolyn Chia-Yu Liu, Toral Bhakta, Dahlia M Hassani, Chien-Chang Lee
Author Information
Eric H Chou: Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, United States of America.
Shaynna Mann: Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, United States of America.
Tzu-Chun Hsu: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Wan-Ting Hsu: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Carolyn Chia-Yu Liu: McTimoney College of Chiropractic, School of Health, BPP University, Abingdon, Oxfordshire, United Kingdom.
Toral Bhakta: Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, Texas, United States of America.
Dahlia M Hassani: Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, Texas, United States of America.
Chien-Chang Lee: Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. ORCID
PURPOSE: To determine the trends of infection sites and outcome of sepsis using a national population-based database. MATERIALS AND METHODS: 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. RESULTS: 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%). CONCLUSIONS: 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.
References
Am J Respir Crit Care Med. 2014 May 15;189(10):1204-13
[PMID: 24635548]
