Incidence, risk factors and impact on outcomes of secondary infection in patients with septic shock: an 8-year retrospective study

Abstract

Secondary infection in septic patients has received widespread attention, although clinical data are still lacking. The present study was performed on 476 patients with septic shock. Time trends for mortality were analyzed using Spearman’s rank correlation test. Risk factors for secondary infection were investigated by binary logistic regression. The extended Cox model with time-varying covariates and hazard ratios (HR) was performed to determine the impact of secondary infection on mortality. Differences in hospital length of stay (LOS) between patients with and without secondary infection were calculated using a multistate model. Thirty-nine percent of septic shock patients who survived the early phase of the disease developed secondary infection. There was a statistically significant increased odds ratio for secondary infection in older patients and patients with a longer LOS in the intensive care unit (ICU), a higher Sequential Organ Failure Assessment (SOFA) score, and endotracheal intubation. Secondary infection significantly reduced the rate of discharge (HR 5.607; CI95 3.612–8.704; P < 0.001) and was associated with an increased hospital LOS of 5.46 days. The present findings represent a direct description of secondary infection in septic shock patients and highlight the influence of this condition on septic shock outcomes.

Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study

“…Deep venous catheterization was also common in ICU setting and our finding was consistent with the study by van Vught et al that it was also an independent risk factor of secondary infection [4]. It's also proved by previous studies that the need for mechanical ventilation of critical ill patients incurred high prevalence of ventilator-associated pneumonia, which accounted for nearly half of nosocomial infections [3,4,37]. Blood transfusion was also a potential risk factor due to the effect of transfusion-related immune modulation (TRIM) as reveal by previous studies [38][39][40][41].…”

“…In our study, we treated in-hospital LOS as an outcome of secondary infection, rather than a potential risk factor. A multistate model with 4 states (state 0: admission, state 1: development of secondary infection, state 2: being discharged alive, state 3: in-hospital death) was performed using "etm" package in R in order to explore the influence of secondary infection on in-hospital LOS [3,26], where the data of patients with an in-hospital LOS longer than 100 days were omitted to eliminate the impact of extreme cases (see Additional file 1: Fig. S1).…”

Frontline Science: Endotoxin-induced immunotolerance is associated with loss of monocyte metabolic plasticity and reduction of oxidative burst

“…Given that, in experimental endotoxemia, already major (long‐lasting) defects in metabolic plasticity of monocytes were observed, we envision that during sepsis the severe impact on the immune system may trigger even more severe changes in cellular metabolism. This possibly contributes to the sustained immune dysfunction in septic patients, who develop secondary infections days to weeks after diagnosis …”

Dynamics of monocytic HLA-DR expression differs between bacterial etiologies during the course of bloodstream infection

“…pneumoniae BSI are confounded by the focus of infection. However, urinary tract infection is shown to be an uncommon primary infection in patients who develop secondary infections [ 30 ]. This is also supported by the autopsy study by Torgesen [ 7 ], in which pyelonephritis was an uncommon site of unresolved septic foci.…”