Department of Clinical Microbiology, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland.
Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland.
Ir J Med Sci. 2021 May;190(2):763-769. doi: 10.1007/s11845-020-02387-0. Epub 2020 Sep 25.
The true incidence of sepsis in surgical cohorts in Ireland remains unclear. According to inpatient audits, patients in surgical diagnostic groups (DRG) who developed sepsis had a longer length of stay and higher mortality rate compared with medical DRG patients who developed sepsis.
We investigated sepsis incidence on a general surgical ward to identify risk factors and strategies to improve management.
Demographics, admission and discharge details, infection risk factors, infection, and sepsis were studied prospectively on a surgical ward in July 2018.
The mean age of 164 patients was 60.5 years (range 18-93 years), 107 (65.2%) were admitted electively, 16 (9.8%) were colonised with a multidrug-resistant organism (MDRO), and 30 (18.3%) were classified as frail on admission. Twelve (7.3%) developed sepsis (ward sepsis rate 118.2/10,000 bed days used). 'Sepsis' was documented in six cases and the national sepsis screening form used in four patients. Patients with sepsis were three times as likely to be MDRO-colonised (OR 3.56; 95% CI = 0.86-14.82; p = 0.065) or frail (OR 3.63; 95% CI = 1.07-12.35; p = 0.03), four times as likely to be an inpatient at the end of the study (OR 4.22, 96% CI 1.23-14.49; p = 0.01), and three times as likely to be readmitted (OR 3.46, 95% CI 1.02-11.76; p = 0.03).
Sepsis was under-documented, and barriers exist with use of the national sepsis screening form. Frailty, which is a sepsis risk factor, should be assessed pre-operatively to maximise prevention.
爱尔兰外科患者中脓毒症的真实发病率尚不清楚。根据住院患者审核，与发生脓毒症的内科诊断组（DRG）患者相比，外科诊断组（DRG）发生脓毒症的患者住院时间更长，死亡率更高。
我们调查了普通外科病房的脓毒症发病率，以确定危险因素和改善管理的策略。
2018 年 7 月，我们对一家外科病房的人口统计学、入院和出院详细信息、感染危险因素、感染和脓毒症进行了前瞻性研究。
164 例患者的平均年龄为 60.5 岁（18-93 岁），107 例（65.2%）为择期入院，16 例（9.8%）为多重耐药菌定植，30 例（18.3%）入院时身体虚弱。12 例（7.3%）发生脓毒症（病房脓毒症发生率为 118.2/10000 个床位日）。在 6 例患者中记录了“脓毒症”，在 4 例患者中使用了国家脓毒症筛查表。脓毒症患者发生多重耐药菌定植的可能性是未发生者的 3 倍（比值比 3.56；95%置信区间 0.86-14.82；p = 0.065）或身体虚弱的可能性是未发生者的 3 倍（比值比 3.63；95%置信区间 1.07-12.35；p = 0.03），在研究结束时作为住院患者的可能性是未发生者的 4 倍（比值比 4.22，96%置信区间 1.23-14.49；p = 0.01），再次入院的可能性是未发生者的 3 倍（比值比 3.46，95%置信区间 1.02-11.76；p = 0.03）。
脓毒症记录不足，使用国家脓毒症筛查表存在障碍。虚弱是脓毒症的一个危险因素，应在术前进行评估，以最大限度地预防。
