Incidence and risk factors for sepsis in surgical patients: A cohort study

Elias, Adriana Cristina Galbiati Parminondi; Matsuo, Taiji; Grion, Cíntia Magalhães Carvalho; Cardoso, Lucienne Tibery Queiroz; Verri, Paulo Henrique

doi:10.1016/j.jcrc.2011.08.001

Cited by 34 publications

(21 citation statements)

References 33 publications

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“…In the present study, infection was an important complication in patients admitted to the ICU and was found at a higher rate than that described in the literature (1,5,7,19). Previously, two observational studies reported an infection frequency of 29.3 and 24.7% in the SICU (5,20).…”

Section: Discussioncontrasting

confidence: 53%

“…Surgical patients admitted to intensive care units (ICUs) are generally older, with a preexistent chronic condition and a poor nutritional status that could be associated with diverse mortality causes (1,5). Major postoperative complications are uncommon, occurring in less than 20% of patients, but these patients have a four-fold higher mortality rate than patients without complications (6).…”

Section: Introductionmentioning

confidence: 99%

“…In a prospective cohort study including 75 ICUs in Brazil, the mortality rates of patients with severe sepsis and septic shock were 34.4 and 65.3%, respectively (9). An observational study in surgical patients revealed incidences of severe sepsis and septic shock of 5 and 11.5%, respectively, while the mortality rates were 48.4% for severe sepsis and 70.8% for septic shock (5). …”

Section: Introductionmentioning

confidence: 99%

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Infection as an independent risk factor for mortality in the surgical intensive care unit

Toufen¹,

Franca²,

Okamoto³

et al. 2013

Clinics

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OBJECTIVES:Medical and surgical intensive care unit patients represent two different populations and require different treatment approaches. The aim of this study was to investigate the parameters associated with mortality in medical and surgical intensive care units.METHODS:This was a prospective cohort study of adult patients admitted to a medical and surgical intensive care unit teaching hospital over an 11-month period. Factors associated with mortality were explored using logistic regression analysis.RESULTS:In total, 827 admissions were observed, and 525 patients >18 years old and with a length of stay >24 h were analyzed. Of these patients, 227 were in the medical and 298 were in the surgical intensive care unit. The surgical patients were older (p<0.01) and had shorter lengths of stay (p<0.01). The mortality in the intensive care unit (35.1 vs. 26.2, p = 0.02) and hospital (48.8 vs. 35.5, p<0.01) was higher for medical patients. For patients in the surgical intensive care unit, death was independently associated with the need for mechanical ventilation, prognostic score (SAPS II), community-acquired infection, nosocomial infection, and intensive care unit-acquired infection. For patients in the medical intensive care unit, death was independently associated with the need for mechanical ventilation and prognostic score.CONCLUSIONS:Although the presence of infection is associated with a high mortality in both the medical and surgical intensive care units, the results of this prospective study suggest that infection has a greater impact in patients admitted to the surgical intensive care unit. Measures and trials to prevent and treat sepsis may be most effective in the surgical intensive care unit population.

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Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Infection as an independent risk factor for mortality in the surgical intensive care unit

Toufen¹,

Franca²,

Okamoto³

et al. 2013

Clinics

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“…are all strongly associated with poor outcome. A recent multivariate analysis identified emergency surgery, mechanical ventilation, fluid resuscitation, and use of vasoactive drugs in the postoperative period as the strongest indicators of risk of sepsis [19]. Other studies suggest use of artificial feeding regimens, both enteral and parenteral, as major contributors to ICU-associated sepsis; catheter-related sepsis is reported to occur in about 25% of patients fed via intravenous feeding-tubes [20].…”

Section: Artificial Nutrition—a Major Contributor To Sepsismentioning

confidence: 99%

Nutrition of the Critically Ill — A 21st-Century Perspective

Bengmark

2013

Nutrients

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Health care-induced diseases constitute a fast-increasing problem. Just one type of these health care-associated infections (HCAI) constitutes the fourth leading cause of death in Western countries. About 25 million individuals worldwide are estimated each year to undergo major surgery, of which approximately 3 million will never return home from the hospital. Furthermore, the quality of life is reported to be significantly impaired for the rest of the lives of those who, during their hospital stay, suffered life-threatening infections/sepsis. Severe infections are strongly associated with a high degree of systemic inflammation in the body, and intimately associated with significantly reduced and malfunctioning GI microbiota, a condition called dysbiosis. Deranged composition and function of the gastrointestinal microbiota, occurring from the mouth to the anus, has been found to cause impaired ability to maintain intact mucosal membrane functions and prevent leakage of toxins—bacterial endotoxins, as well as whole bacteria or debris of bacteria, the DNA of which are commonly found in most cells of the body, often in adipocytes of obese individuals or in arteriosclerotic plaques. Foods rich in proteotoxins such as gluten, casein and zein, and proteins, have been observed to have endotoxin-like effects that can contribute to dysbiosis. About 75% of the food in the Western diet is of limited or no benefit to the microbiota in the lower gut. Most of it, comprised specifically of refined carbohydrates, is already absorbed in the upper part of the GI tract, and what eventually reaches the large intestine is of limited value, as it contains only small amounts of the minerals, vitamins and other nutrients necessary for maintenance of the microbiota. The consequence is that the microbiota of modern humans is greatly reduced, both in terms of numbers and diversity when compared to the diets of our paleolithic forebears and the individuals living a rural lifestyle today. It is the artificial treatment provided in modern medical care—unfortunately often the only alternative provided—which constitute the main contributors to a poor outcome. These treatments include artificial ventilation, artificial nutrition, hygienic measures, use of skin-penetrating devices, tubes and catheters, frequent use of pharmaceuticals; they are all known to severely impair the microbiomes in various locations of the body, which, to a large extent, are ultimately responsible for a poor outcome. Attempts to reconstitute a normal microbiome by supply of probiotics have often failed as they are almost always undertaken as a complement to—and not as an alternative to—existing treatment schemes, especially those based on antibiotics, but also other pharmaceuticals.

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“…All these targets require support in the critical-care unit. However, despite such support, the presence of septic shock or severe sepsis is still associated with high mortality, in both developed and developing countries (Beovic et al, 2008;Cheng et al, 2007;Elias et al, 2012;Jaramillo-Bustamante et al, 2012;Khan et al, 2012;Moore et al, 2011;Pociello Alminana et al, 2007;Suka et al, 2006;Vincent and Atalan, 2008;Wang et al, 2006).…”

Section: Introductionmentioning

confidence: 99%