Edathadathil Fabia, Alex Soumya, Prasanna Preetha, Sudhir Sangita, Balachandran Sabarish, Moni Merlin, Menon Vidya, Sathyapalan Dipu T, Singh Sanjeev
Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences and Research Centre, Kochi 682041, Kerala, India.
Department of Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi 682041, Kerala, India.
Pathogens. 2022 Oct 24;11(11):1226. doi: 10.3390/pathogens11111226.
The study aims to characterize community-acquired sepsis patients admitted to our 1300-bedded tertiary care hospital in South India from the Surviving Sepsis Campaign (SSC) guideline-compliant e-sepsis registry stratified by focus of infection. The prospective observational study recruited 1009 adult sepsis patients presenting to the emergency department at the center based on Sepsis-2 criteria for a period of three years. Of the patients, 41% were between 61 and 80 years with a mean age of 57.37 ± 13.5%. A total of 13.5% (136) was under septic shock and in-hospital mortality for the study cohort was 25%. The 3 h and 6 h bundle compliance rates observed were 37% and 49%, respectively, without significant survival benefits. Predictors of mortality among patients with bloodstream infections were septic shock ( = 0.01, OR 2.4, 95% CI 1.23-4.79) and neutrophil-to-lymphocyte ratio ( = 0.008, OR 1.01, 95% CI 1.009-1.066). The presence of Acinetobacter ( = 0.005, OR 4.07, 95% CI 1.37-12.09), Candida non-albicans ( = 0.001, OR16.02, 95% CI 3.0-84.2) and septic shock ( = 0.071, OR 2.5, 95% CI 0.97-6.6) were significant predictors of mortality in patients with community-acquired pneumonia. The registry has proven to be a key data source detailing regional microbial etiology and clinical outcomes of adult sepsis patients, enabling comprehensive evaluation of regional community-acquired sepsis to tailor institutional sepsis treatment protocols.
该研究旨在对印度南部一家拥有1300张床位的三级护理医院收治的社区获得性脓毒症患者进行特征描述，这些患者来自符合拯救脓毒症运动（SSC）指南的电子脓毒症登记系统，并按感染部位进行分层。这项前瞻性观察性研究基于脓毒症-2标准，在三年时间里招募了1009名到该中心急诊科就诊的成年脓毒症患者。在这些患者中，41%的患者年龄在61至80岁之间，平均年龄为57.37±13.5%。共有13.5%（136例）处于感染性休克状态，该研究队列的院内死亡率为25%。观察到的3小时和6小时集束化治疗依从率分别为37%和49%，但没有显著的生存获益。血流感染患者的死亡预测因素为感染性休克（P = 0.01，比值比2.4，95%置信区间1.23 - 4.79）和中性粒细胞与淋巴细胞比值（P = 0.008，比值比1.01，95%置信区间1.009 - 1.066）。不动杆菌属感染（P = 0.005，比值比4.07，95%置信区间1.37 - 12.09）、非白色念珠菌感染（P = 0.001，比值比16.02，95%置信区间3.0 - 84.2）和感染性休克（P = 0.071，比值比2.5，95%置信区间0.97 - 6.6）是社区获得性肺炎患者死亡的显著预测因素。该登记系统已被证明是一个关键的数据源，详细记录了成年脓毒症患者的区域微生物病因和临床结局，有助于对区域社区获得性脓毒症进行全面评估，以制定机构性脓毒症治疗方案。
