Clinic for Anesthesiology and Intensive Care, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany.
Crit Care. 2011 Jul 28;15(4):R183. doi: 10.1186/cc10332.
Recent models capturing the pathophysiology of sepsis and ex-vivo data from patients are speculating about immunosuppression in the so-called late phase of sepsis. Clinical data regarding survival and microbiological burden are missing. The aim of this study was to determine the clinical significance of the 'late phase' of sepsis with respect to overall survival and occurrence of microbiological findings.
In a retrospective trial, 16,041 patient charts from a university intensive care unit were screened, and 999 patients with severe sepsis or septic shock were identified. Three phases were established according to the mortality peaks which were separated by two distinct nadirs: phase I (days 1 to 5), phase II (days 6 to 15) and phase III (days 16 to 150). Patients were analyzed for outcome, SOFA scores, procalcitonin levels, antimicrobial treatment, dialysis, mechanical ventilation and results of blood cultures during their hospital stay.
Out of 999 enrolled patients, 308 died during the course of sepsis presenting a characteristic mortality rate (30.8%) with three distinct mortality peaks (at days 2, 7 and 17). Overall 36.7% of all deaths occurred in the early phase (phase I) and 63.3% during the later phases (phase II + III). In total 2,117 blood cultures were drawn. In phase I, 882 blood cultures were drawn, representing a sampling rate of 88% with a positive rate of 14.9%. In phase II, 461 samples were taken, indicating a sampling rate of 52% and a positive rate of 11.3%. Within phase III, 524 samples were obtained representing a sampling rate of 66% with a positive rate of 15.3%, which was significantly higher compared to the positive rate of phase II and similar to phase I. In particular, the rate of typically opportunistic bacteria increased significantly from 9% in phase I up to 18% in phase III. The same is true for Candida spp. (phase I 13%, phase III 30%).
The later phase of sepsis is associated with a significant re-increase of positive blood culture results, especially regarding opportunistic bacteria and fungi. These observations warrant further studies focusing on the underlying mechanisms resulting in this outcome burden in the later phase of sepsis.
最近的模型捕捉到了脓毒症的病理生理学和患者的体外数据，推测在脓毒症的所谓晚期存在免疫抑制。关于生存和微生物负担的临床数据尚不清楚。本研究的目的是确定“晚期”脓毒症与总生存率和微生物学发现的发生相关的临床意义。
在一项回顾性试验中，筛选了来自一所大学重症监护病房的 16041 份患者病历，确定了 999 名严重脓毒症或感染性休克患者。根据死亡率峰值建立了三个阶段，这些峰值通过两个明显的低谷分开：第一阶段（第 1 天至第 5 天）、第二阶段（第 6 天至第 15 天）和第三阶段（第 16 天至第 150 天）。在住院期间，对患者的结局、SOFA 评分、降钙素原水平、抗菌治疗、透析、机械通气和血培养结果进行分析。
在纳入的 999 名患者中，有 308 名在脓毒症过程中死亡，死亡率为 30.8%，有三个明显的死亡率高峰（第 2、7 和 17 天）。总体而言，所有死亡中有 36.7%发生在早期（第一阶段），63.3%发生在晚期（第二阶段+第三阶段）。共抽取了 2117 份血培养。在第一阶段抽取了 882 份血培养，采样率为 88%，阳性率为 14.9%。在第二阶段，抽取了 461 份样本，采样率为 52%，阳性率为 11.3%。在第三阶段，抽取了 524 份样本，采样率为 66%，阳性率为 15.3%，明显高于第二阶段，与第一阶段相似。特别是，机会性细菌的阳性率从第一阶段的 9%显著上升至第三阶段的 18%。念珠菌属也是如此（第一阶段 13%，第三阶段 30%）。
脓毒症的晚期与阳性血培养结果的显著再次增加相关，尤其是关于机会性细菌和真菌。这些观察结果需要进一步研究，以关注导致脓毒症晚期这种结果负担的潜在机制。
