A Comparative Study to Assess the Determinants and Outcomes of Sepsis Treated in Medical Wards and ICU in an Indian Teaching Hospital
Determinants and outcomes of sepsis
Background: Sepsis is a systemic, deleterious host response to infection. Severe sepsis is defined as acute organ dysfunction secondary to documented or suspected infection and septic shock is severe sepsis with hypotension not reversed by fluid resuscitation. The present study was conducted to assess the determinants and outcomes of sepsis treated in medical wards and ICU. Subjects and Methods: The study was done at Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka. 320 patients with sepsis of both genders were divided into 2 groups. Group I patients were admitted to the medical ward and group II to ICU. Clinical examination and laboratory tests were done. Results: Source of infection was a urinary tract in 12% in group I and 11% in group II, a respiratory tract in 40% in group IU and 32% in group II, GIT in 25% and 22% in group I and II respectively, blood infection in 15% and 20% in group I and II respectively and soft tissue infection in 8% and 15% in group I and II respectively. The difference was significant (P< 0.05). Appropriate specimen culture was present in 75 in group I and 64 in group II and blood culture in 42 in group I and 23 in group II. The difference was non-significant (P> 0.05). Conclusion: Clinical features and co-morbidities were higher in ICU patients as compared to the medical ward.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303– 1310. Available from: https://dx.doi.org/10.1097/00003246-200107000-00002.
Quenot JP, Binquet C, Kara F, Martinet O, Ganster F, Navellou JC. The epidemiology of septic shock in French intensive care units: the prospective multicenter cohort EPISS study. Crit Care. 2013;17(2):65. Available from: https://doi.org/10.1186/cc12598.
Martin GS, Mannino DM, Eaton S, Moss M. The Epidemiology of Sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–1554. Available from: https://dx.doi.org/10.1056/nejmoa022139.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. N Engl J Med. 2001;345(19):1368–1377. Available from: https://dx.doi.org/10.1056/nejmoa010307.
Kollef MH. Broad-Spectrum Antimicrobials and the Treatment of Serious Bacterial Infections: Getting It Right Up Front. Clin Infect Dis. 2008;47(S1):3–13. Available from: https://dx.doi.org/10.1086/590061.
Rohde JM, Odden AJ, Bonham C, Kuhn L, Malani PN, Chen LM, et al. The epidemiology of acute organ system dysfunction from severe sepsis outside of the intensive care unit. J Hosp Med. 2013;8(5):243–247. Available from: https://dx.doi.org/10.1002/jhm.2012.
Harbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pittet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med. 2003;115(7):529–535. Available from: https://dx.doi.org/10.1016/j.amjmed.2003.07.005.
Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The Influence of Inadequate Antimicrobial Treatment of Bloodstream Infections on Patient Outcomes in the ICU Setting. Chest. 2000;118(1):146–155. Available from: https://dx.doi.org/10.1378/chest.118.1.146.
Carmona-Torre F, Martinez-Urbistondo D, Landecho MF, Lucena JF. Surviving sepsis in an intermediate care unit. Lancet Infect Dis. 2013;13(4):294–295. Available from: https://dx.doi.org/10.1016/s1473-3099(13)70072-0.
Bion J. Surviving sepsis: a systems issue. Lancet Infect Dis. 2012;12(12):898–899. Available from: https://dx.doi.org/10.1016/s1473-3099(12)70263-3.
Bhattacharya PK, Gautom D, Nath N, Saikia H. A comparative study to assess the determinants and outcomes of sepsis treated in medical wards and ICU in an Indian teaching hospital. J Clin Diagn Res. 2016;10(6):1–6. Available from: https://doi.org/10.7860/jcdr/2016/18114.7949.
Marik PE. Surviving sepsis: going beyond the guidelines. Ann Intensive Care. 2011;1(1):1–17. Available from: https://dx.doi.org/10.1186/2110-5820-1-17.
Copyright (c) 2020 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.