Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study

Chou, Eric; Mann, Shaynna M.; Hsu, Tien-Pen; Hsu, Wan‐Ting; Liu, Carolyn Chia Yu; Bhakta, Toral; Hassani, Dahlia; Lee, Chien‐Chang

doi:10.1371/journal.pone.0227752

Cited by 53 publications

(39 citation statements)

References 35 publications

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“…The large number of our cohort, the extensive variables considered during analyses, and a sufficient follow-up duration all increase the validity of our findings. The strategy of defining the exposure (frailty) and outcome (UTI) variable in this study has been adopted in the existing literature [ 14 , 15 , 31 , 33 ], with credible results obtained. However, several features of this study warrant consideration before cautiously interpreting our findings.…”

Section: Discussionmentioning

confidence: 99%

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Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease

et al. 2021

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Background Patients with diabetic mellitus (DM) and chronic kidney disease (CKD) are at an increased risk of urinary tract infection (UTI) due to their altered immunological integrity. These patients are similarly prone to developing frailty, a state of cumulative health deficits involving multiple domains and leading to adverse outcomes. Whether frailty predisposes affected individuals to UTI among patients with DM and CKD remains unclear. Methods A population-based cohort of patients with DM and CKD (n = 79,887) were assembled from the Longitudinal Cohort of Diabetes Patients, with their baseline frailty status measured by a modified FRAIL scale. We analyzed their risk of developing UTI depending on their severity of frailty, after accounting demographic profiles, lifestyle factors, comorbidities, concurrent medications, and major interventions. A secondary analysis focused on the risk of urosepsis related to frailty. Results Among all participants, 36.1 %, 50.3 %, 12.8 %, and 0.8 % did not have or had 1, 2, and ≥ 3 FRAIL items, respectively, at baseline. After 3.51 years, 11,175 UTI events occurred. Kaplan-Meier analysis showed that participants with DM, CKD and an increasing number of FRAIL items had successively higher incidence of UTI than those without any FRAIL items (log rank p < 0.001). Cox proportional hazard modeling revealed that after accounting for all confounders, those with more severe frailty exhibited a significantly higher risk of incident UTI (for groups of 1, 2, and ≥ 3 FRAIL items, hazard ratio 1.19, 1.24, and 1.43, respectively; all p < 0.001) than those without. An 11 % risk elevation for UTI could be observed for every FRAIL item increase. Participants with more severe frailty exhibited a trend of having higher risk of urosepsis as well. Conclusions Having frailty predicted a higher risk of developing UTI in the future in patients with DM and CKD. It would be prudent to screen for frailty in these patients and provide optimal frailty-directed management to attenuate their risk of UTI and improve their outcomes.

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Section: Discussionmentioning

confidence: 99%

“…The secondary endpoint was the development of urosepsis, a more severe complication of UTI, defined by the combination of UTI and sepsis diagnoses. The diagnostic codes of sepsis were also derived from existing reports [ 32 , 33 ].…”

Section: Methodsmentioning

confidence: 99%

Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease

et al. 2021

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“…Sepsis is caused by an infection, and the primary site of infection is most commonly the respiratory tract (64%), followed by the abdomen (20%) and urogenital tract (14%). Intra-abdominal infection is associated with the highest mortality (30.7%) ( 8 ). In most cases, sepsis is caused by gram-positive or gram-negative bacteria, but also fungi, viruses, and parasites can cause sepsis.…”

Section: The Sepsis Burdenmentioning

confidence: 99%

Glucocorticoids in Sepsis: To Be or Not to Be

Vandewalle

Libert

2020

Front. Immunol.

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“…In the United States, severe sepsis and septic shock remain the dominant cause of death in intensive care units (ICUs), with approximately 900,000–3,000,000 cases yearly [ 2 ]. Economically, sepsis was ranked in the top four most expensive conditions, costing an aggregate of $20,298,000 yearly in US hospitals [ 3 , 4 ]. Mortality from severe sepsis and septic shock remains unacceptably high, ranging between 20 and 40% depending on the severity of illness [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing mortality between positive and negative blood culture results: an inverse probability of treatment weighting analysis of a multicenter cohort

Liu

Nie

et al. 2021

BMC Infect Dis

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Background The association between blood culture status and mortality among sepsis patients remains controversial hence we conducted a tri-center retrospective cohort study to compare the early and late mortality of culture-negative versus culture-positive sepsis using the inverse probability of treatment weighting (IPTW) method. Methods Adult patients with suspected sepsis who completed the blood culture and procalcitonin tests in the emergency department or hospital floor were eligible for inclusion. Early mortality was defined as 30-day mortality, and late mortality was defined as 30- to 90-day mortality. IPTW was calculated from propensity score and was employed to create two equal-sized hypothetical cohorts with similar covariates for outcome comparison. Results A total of 1405 patients met the inclusion criteria, of which 216 (15.4%) yielded positive culture results and 46 (21.3%) died before hospital discharge. The propensity score model showed that diabetes mellitus, urinary tract infection, and hepatobiliary infection were independently associated with positive blood culture results. There was no significant difference in early mortality between patients with positive or negative blood culture results. However, culture-positive patients had increased late mortality as compared with culture-negative patients in the full cohort (IPTW-OR, 1.95, 95%CI: 1.14–3.32) and in patients with severe sepsis or septic shock (IPTW-OR, 1.92, 95%CI: 1.10–3.33). After excluding Staphylococcal bacteremia patients, late mortality difference became nonsignificant (IPTW-OR, 1.78, 95%CI: 0.87–3.62). Conclusions Culture-positive sepsis patients had comparable early mortality but worse late mortality than culture-negative sepsis patients in this cohort. Persistent Staphylococcal bacteremia may have contributed to the increased late mortality.

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Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study

Abstract: To determine the trends of infection sites and outcome of sepsis using a national population-based database.

Cited by 53 publications

References 35 publications

Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease

Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease

Glucocorticoids in Sepsis: To Be or Not to Be

Comparing mortality between positive and negative blood culture results: an inverse probability of treatment weighting analysis of a multicenter cohort

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