Infectious Foci, Comorbidities and Its Influence on the Outcomes of Septic Critically Ill Patients.

Ana Maria Oliveira, Andr�� Oliveira, Raquel Vidal, Jo��o Gon��alves-Pereira
Author Information
  1. Ana Maria Oliveira: Unidade Cuidados Intensivos, Unidade Local de Sa��de Estu��rio do Tejo, 2600-009 Vila Franca de Xira, Portugal.
  2. Andr�� Oliveira: Unidade Cuidados Intensivos, Unidade Local de Sa��de Estu��rio do Tejo, 2600-009 Vila Franca de Xira, Portugal. ORCID
  3. Raquel Vidal: Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal.
  4. Jo��o Gon��alves-Pereira: Unidade Cuidados Intensivos, Unidade Local de Sa��de Estu��rio do Tejo, 2600-009 Vila Franca de Xira, Portugal. ORCID

Abstract

Sepsis is among the most frequent diagnoses on admission to the intensive care unit (ICU). A systemic inflammatory response, activated by uncontrolled infection, fosters hypoperfusion and multiorgan failure and often leads to septic shock and mortality. These infections arise from a specific anatomic source, and how the infection foci influence the outcomes is unknown. All patients admitted to the ICU of Hospital de Vila Franca de Xira, between 1 January 2017 and 31 June 2023, were screened for sepsis and categorized according to their infection foci. During the study period, 1296 patients (32.2%) had sepsis on admission. Their mean age was 67.5 �� 15.3 and 58.1% were male; 73.0% had community-acquired infections. The lung was the main focus of infection. Septic shock was present in 37.9% of the patients and was associated with hospital mortality. Severe imbalances were noted in its incidence, and there was lower mortality in lung infections. The hospital-acquired infections had a slightly higher mortality but, after adjustment, this difference was non-significant. Patients with secondary bacteremia had a worse prognosis (one-year adjusted hazard ratio of 1.36, 95% confidence interval 1.06-1.74, = 0.015), especially those with an isolated non-fermenting Gram-negative infection. Lung, skin, and skin structure infections and peritonitis had a worse prognosis, whilst urinary, biliary tract, and other intra-abdominal infections had a better one-year outcome.

Keywords

References

  1. Indian J Microbiol. 2017 Mar;57(1):1-10 [PMID: 28148975]
  2. JAMA Surg. 2022 Sep 1;157(9):817-826 [PMID: 35830181]
  3. Antibiotics (Basel). 2022 Dec 18;11(12): [PMID: 36551496]
  4. Infect Dis (Lond). 2016 Oct;48(10):726-31 [PMID: 27389656]
  5. N Engl J Med. 2012 May 31;366(22):2055-64 [PMID: 22616830]
  6. Intensive Care Med. 2020 Feb;46(2):266-284 [PMID: 32047941]
  7. Intensive Care Med. 2021 Nov;47(11):1181-1247 [PMID: 34599691]
  8. BMC Infect Dis. 2014 Jul 29;14:420 [PMID: 25074742]
  9. Eur Geriatr Med. 2021 Oct;12(5):1057-1064 [PMID: 33646536]
  10. Crit Care. 2013 Apr 25;17(2):R65 [PMID: 23561510]
  11. Crit Care. 2019 Jun 6;23(1):202 [PMID: 31171006]
  12. Clin Microbiol Infect. 2014 Dec;20(12):1308-15 [PMID: 24975209]
  13. JAMA. 2016 Feb 23;315(8):801-10 [PMID: 26903338]
  14. Crit Care Med. 2018 Jun;46(6):997-1000 [PMID: 29767636]
  15. Biomedicines. 2023 Aug 09;11(8): [PMID: 37626728]
  16. Clin Microbiol Infect. 2013 Mar;19(3):242-8 [PMID: 22360358]
  17. J Intensive Care. 2019 May 03;7:28 [PMID: 31073407]
  18. Sci Adv. 2022 Dec 14;8(50):eadd0924 [PMID: 36516248]
  19. J Intensive Care Med. 2017 Sep;32(8):473-479 [PMID: 26880006]
  20. Infect Drug Resist. 2020 Aug 12;13:2811-2817 [PMID: 32848430]
  21. Crit Care. 2013 Jan 25;17(1):109 [PMID: 23351425]
  22. Infect Drug Resist. 2021 Oct 12;14:4191-4205 [PMID: 34675564]
  23. Crit Care. 2014 May 02;18(3):R87 [PMID: 24886954]
  24. Crit Care Med. 2006 Feb;34(2):344-53 [PMID: 16424713]
  25. Br J Anaesth. 2017 Oct 01;119(4):626-636 [PMID: 29121281]
  26. Aust Crit Care. 2024 Sep;37(5):734-739 [PMID: 38649316]
  27. Crit Care. 2020 May 19;24(1):239 [PMID: 32430052]
  28. J Infect Dis. 2006 Jan 15;193(2):251-8 [PMID: 16362889]
  29. Yale J Biol Med. 2019 Dec 20;92(4):629-640 [PMID: 31866778]
  30. Front Med (Lausanne). 2022 Jul 13;9:915224 [PMID: 35911394]
  31. Crit Care. 2020 May 7;24(1):203 [PMID: 32381107]
  32. Eur Respir J. 2014 Feb;43(2):545-53 [PMID: 23845720]
  33. Med Intensiva (Engl Ed). 2024 Feb;48(2):85-91 [PMID: 37985339]
  34. BMJ. 2016 May 17;353:i2375 [PMID: 27189000]
  35. BMC Infect Dis. 2022 Feb 10;22(1):142 [PMID: 35144551]
  36. Crit Care Explor. 2023 Aug 21;5(8):e0955 [PMID: 37614801]
  37. Crit Care. 2019 May 31;23(1):196 [PMID: 31151462]
  38. J Antimicrob Chemother. 2010 Jun;65(6):1276-85 [PMID: 20335186]
  39. Cureus. 2023 Dec 6;15(12):e50033 [PMID: 38186542]
  40. J Crit Care. 2018 Feb;43:183-189 [PMID: 28915392]
  41. Front Microbiol. 2024 Feb 20;15:1370818 [PMID: 38444801]
  42. JAMA. 2020 Apr 21;323(15):1478-1487 [PMID: 32207816]
  43. Scand J Trauma Resusc Emerg Med. 2019 Feb 14;27(1):19 [PMID: 30764843]
  44. Med Sci Monit. 2019 Aug 23;25:6331-6340 [PMID: 31441459]

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