Epidemiology of sepsis in brazilian icus: a nationwide stratified sample

Machado, FR; Cavalcanti, AB; Bozza, FA; Angus, DC; Ferreira, E L A; Carrara, F; Lubarino, J; Salomão, Reinaldo; Azevedo, LC Pontes de

doi:10.1186/2197-425x-3-s1-a642

Cited by 19 publications

(20 citation statements)

References 3 publications

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“…Respiratory failure was detected in 26% of patients and with mortality rate (76.9%), which was highest rate in compare to other study [39]. High mortality rates for sepsis and septic shock in our study was (68%), This figure also has been in other studies in other middle and low-income countries, the overall mortality rate of severe sepsis was (55.7%) in Brazil in 2015 [40], (64.6%) in India in 2007 [41] and (49.7%) in Thailand in 2009 [42]. The poor survival rate in developing countries related to many factors such as lack of resources, lack of standardized sepsis local protocol, unavailability of blood cultures, and lack of awareness.…”

Section: Compicationssupporting

confidence: 80%

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Ahmad¹,

Ismaeel

Mohammed

et al. 2018

KJAR

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Sepsis is a very common condition in emergency hospitals and presentation is variable, it is under diagnosed with very high mortality rate. All patients with infection are at risk of developing sepsis. Sepsis is a complex condition characterized by activation of inflammatory process and coagulation system in response to microbial insult. An observational prospective study was carried out at RozhHalat emergency hospital in Erbil-Kurdistan region of Iraq between February 2017 to January 2018.The study was approved by the scientific and ethical committee of Kurdistan board of medical specialties. 50 patients aged between (10 -80) years old presented to this hospital with sign and symptoms of infection were recruited to this study. 50 patients with signs and symptoms of sepsis were recorded in this study. The mean age was 47 with male to female ration of 2:3 (42% male and 58% female). The overall mortality rate was high at 68% with higher rate among female and older age group. The blood culture was positive in 74% of cases of which 52% were gram positive and 22% were gram-negative microorganisms. A Positive blood culture associated with higher mortality rate of 81% compared with 21% if the blood culture was negative. In majority of cases the site of infection was from multiple source (34%) followed by respiratory infection (26%).Skin and soft tissue infection was associated with the lowest mortality of 2.9%. High number of cases (82%) developed complications and 52% of cases developed more than 2 organ failures. All patients received empirical antibiotic therapy however 46% of cases received the wrong antimicrobials. The survival rate was higher (44%) among patients given the right antibiotics. Similarly patients had better chance of survival if appropriate fluid resuscitation therapy was give. The overall mortality among vasopressor treated patients were 72% compared with 78% chance of mortality if they were not treated with any vasopressor therapy, among those who received inotropic supportNoradrenaline associated with higher survival rate(72%). A qSOFA score of more than 2 associated with 86.4 % of mortality compared with 75.5% mortality with similar SIRS criteria. Factors associated with high mortality were: female gender, older age group, positive blood culture, wrong antibiotics therapy, less fluid resuscitation, multisource of infection, multi-organ failure, high lactic acid level and high qSOFA score. This study shows that sepsis is associated with high overall mortality rate of 68% in the RozhHalat emergency hospital and higher rate of death among female and older age group. Negative blood culture, appropriate use of antibiotics and fluid therapy associated with better chance of survival. Vasopressor therapy did not result in better survival outcome except for Noradrenaline. The qSOFA score is as good as SIRS criteria in predicting mortality. High lactate, multi-organ failure and multisource of infection associated with the worst outcome.

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Section: Compicationssupporting

confidence: 80%

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Ahmad¹,

Ismaeel

Mohammed

et al. 2018

KJAR

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“…The prevalence of severe sepsis was found to be 26% and 22% in two single-day, point prevalence studies performed in 2012 and 2013, respectively, in Polish ICUs [ 32 ]. According to point prevalence surveys, the prevalence of severe sepsis was 29.6% in Brazilian ICUs on a single day 2015 [ 33 ] and 17.9% in German ICUs in 2013 [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…High mortality rates for sepsis and septic shock, similar to that of Turkey, have been reported in other middle- and low-income countries. According to point prevalence surveys, the overall mortality rate of severe sepsis was 55.7% in Brazilian ICUs, 64.6% in Indian ICUs, and 80% in Pakistan ICUs [ 33 , 41 , 42 ]. According to a single-center cohort study, the mortality ratio of septic shock was 82% in Tunisia [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

et al. 2018

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BackgroundThe 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.MethodsA 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.ResultsOf 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.ConclusionsA 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.Trial registrationClinicalTrials.gov ID NCT03249246. Date: August 15, 2017. Retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2013-1) contains supplementary material, which is available to authorized users.

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“…On the contrary, in private ICUs, CT scanners were much more accessible. In fact, although we did not study the relationship of these resources with any outcomes, it has been demonstrated that resource inequality is a determinant of quality of care [ 30 ] and health outcomes in the ICU [ 31 , 32 ], especially in resource-poor settings.…”

Section: Discussionmentioning

confidence: 99%

The practice of intensive care in Latin America: a survey of academic intensivists

Castro

Nin²,

Ríos

et al. 2018

Crit Care

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BackgroundIntensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. The aim of this study was to examine individual- and work-related aspects of the Latin American intensivist workforce, mainly with academic appointments, which might influence the quality of care provided. In consequence, we conducted a cross-sectional study of intensivists at public and private academic and nonacademic Latin American intensive care units (ICUs) through a web-based electronic survey submitted by email. Questions about personal aspects, work-related topics, and general clinical workflow were incorporated.ResultsOur study comprised 735 survey respondents (53% return rate) with the following country-specific breakdown: Brazil (29%); Argentina (19%); Chile (17%); Uruguay (12%); Ecuador (9%); Mexico (7%); Colombia (5%); and Bolivia, Peru, Guatemala, and Paraguay combined (2%). Latin American intensivists were predominantly male (68%) young adults (median age, 40 [IQR, 35–48] years) with a median clinical ICU experience of 10 (IQR, 5–20) years. The median weekly workload was 60 (IQR, 47–70) h. ICU formal training was between 2 and 4 years. Only 63% of academic ICUs performed multidisciplinary rounds. Most intensivists (85%) reported adequate conditions to manage patients with septic shock in their units. Unsatisfactory conditions were attributed to insufficient technology (11%), laboratory support (5%), imaging resources (5%), and drug shortages (5%). Seventy percent of intensivists participated in research, and 54% read scientific studies regularly, whereas 32% read no more than one scientific study per month. Research grants and pharmaceutical sponsorship are unusual funding sources in Latin America. Although Latin American intensivists are mostly unsatisfied with their income (81%), only a minority (27%) considered changing to another specialty before retirement.ConclusionsLatin American intensivists constitute a predominantly young adult workforce, mostly formally trained, have a high workload, and most are interested in research. They are under important limitations owing to resource constraints and overt dissatisfaction. Latin America may be representative of other world areas with similar challenges for intensivists. Specific initiatives aimed at addressing these situations need to be devised to improve the quality of critical care delivery in Latin America.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-1956-6) contains supplementary material, which is available to authorized users.

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Epidemiology of sepsis in brazilian icus: a nationwide stratified sample

Cited by 19 publications

References 3 publications

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Outcome and Management of Sepsis at RozhHalat Emergency Hospital in Erbil –Kurdistan region of Iraq

Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

The practice of intensive care in Latin America: a survey of academic intensivists

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