Department of Anesthesiology, Division of Critical Care, School of Medicine, Kocaeli University, Kocaeli, Turkey.
Department of Infectious Disease, School of Medicine, Uludağ University, Bursa, Turkey.
Crit Care. 2018 Apr 16;22(1):93. doi: 10.1186/s13054-018-2013-1.
The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey.
A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded.
Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients.
A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.
ClinicalTrials.gov ID NCT03249246 . Date: August 15, 2017. Retrospectively registered.
在抗生素耐药率较高的土耳其，脓毒症的流行率和死亡率在很大程度上尚未可知。本项全国性、多中心、时点患病率研究旨在确定土耳其重症监护病房（ICU）中脓毒症的患病率、致病微生物和结局。
共有 94 家医院的 132 个 ICU 参与了本项研究。所有年龄＞18 岁的患者（于研究期间在参与 ICU 就诊或在 24 小时内入住任何时长）均纳入本研究。根据美国胸科医师学会和危重病医学会（ACCP/SCCM）的全身炎症反应综合征（SIRS）、严重脓毒症和脓毒性休克共识标准，评估并记录存在 SIRS、严重脓毒症和脓毒性休克的感染患者的情况。还使用 SEPSIS-III 定义评估脓毒性休克患者。记录患者的人口统计学、疾病严重程度、合并症、微生物学、治疗、住院时间和结局（30 天内死亡/存活）。
在纳入分析的 1499 例患者中，237 例（15.8%）有感染而无 SIRS，163 例（10.8%）有感染合并 SIRS，260 例（17.3%）有严重脓毒症而无休克，203 例（13.5%）有脓毒性休克。严重脓毒症（55.7%）和脓毒性休克（70.4%）患者的死亡率高于仅有感染（24.8%）和感染+SIRS（31.2%）的患者（p＜0.001）。根据 SEPSIS-III，104 例（6.9%）患者有脓毒性休克（死亡率为 75.9%）。呼吸系统（71.6%）是最常见的感染部位，最常见的分离病原体为不动杆菌属（33.7%）。不动杆菌、克雷伯菌和铜绿假单胞菌的碳青霉烯类耐药率分别约为 74.9%、39.1%和 26.5%，但这与更高的死亡率风险无关。年龄、入住 ICU 时的急性生理学和慢性健康评估 II 评分、研究日的序贯器官衰竭评估评分、实体器官恶性肿瘤、严重脓毒症或休克的存在、念珠菌属感染、肾脏替代治疗以及护士与患者的比例（1：4，相比 1：2）是感染患者死亡的独立预测因素。
在土耳其的 ICU 中，脓毒症的高患病率和令人无法接受的高死亡率均很常见。尽管土耳其 ICU 中碳青霉烯类耐药率较高，但与死亡率风险增加无关。
ClinicalTrials.gov 注册号 NCT03249246；日期：2017 年 8 月 15 日；回顾性注册。
