Primary bacteraemia is associated with a higher mortality risk compared with pulmonary and intra-abdominal infections in patients with sepsis: a prospective observational cohort study

Abstract

ObjectiveTo investigate whether common infection foci (pulmonary, intra-abdominal and primary bacteraemia) are associated with variations in mortality risk in patients with sepsis.DesignProspective, observational cohort study.SettingThree surgical intensive care units (ICUs) at a university medical centre.ParticipantsA total of 327 adult Caucasian patients with sepsis originating from pulmonary, intra-abdominal and primary bacteraemia participated in this study.Primary and secondary outcome measuresThe patients were followed for 90 days and mortality risk was recorded as the primary outcome variable. To monitor organ failure, sepsis-related organ failure assessment (Sequential Organ Failure Assessment, SOFA) scores were evaluated at the onset of sepsis and throughout the observational period as secondary outcome variables.ResultsA total of 327 critically ill patients with sepsis were enrolled in this study. Kaplan-Meier survival analysis showed that the 90-day mortality risk was significantly higher among patients with primary bacteraemia than among those with pulmonary and intra-abdominal foci (58%, 35% and 32%, respectively; p=0.0208). To exclude the effects of several baseline variables, we performed multivariate Cox regression analysis. Primary bacteraemia remained a significant covariate for mortality in the multivariate analysis (HR 2.10; 95% CI 1.14 to 3.86; p=0.0166). During their stay in the ICU, the patients with primary bacteraemia presented significantly higher SOFA scores than those of the patients with pulmonary and intra-abdominal infection foci (8.5±4.7, 7.3±3.4 and 5.8±3.5, respectively). Patients with primary bacteraemia presented higher SOFA-renal score compared with the patients with other infection foci (1.6±1.4, 0.8±1.1 and 0.7±1.0, respectively); the patients with primary bacteraemia required significantly more renal replacement therapy than the patients in the other groups (29%, 11% and 12%, respectively).ConclusionsThese results indicate that patients with sepsis with primary bacteraemia present a higher mortality risk compared with patients with sepsis of pulmonary or intra-abdominal origins. These results should be assessed in patients with sepsis in larger, independent cohorts.

The lung is a host defense niche for immediate neutrophil-mediated vascular protection

“…Even for sepsis, which has an incredibly high mortality, the outcomes are worse if bacteremia occurs (2). Conventional paradigms consider most bloodstream invaders are cleared via specialized stationary mononuclear phagocytes in the liver and spleen.…”

“…Of particular concern is that sepsis with bacteremia, or bloodstream infection, has even worse outcomes in humans (2). Bloodstream infections are common both in the community (3–5) and in the hospital (6–9).…”

Characteristics and outcomes of bacteremia among ICU-admitted patients with severe sepsis

“…characteristics and outcomes of severe sepsis patients with and without bacteremia. Several studies have reported on the epidemiology of bacteremia and sepsis, although the quality of such studies is varied 5,9,10,[14][15][16][17] . In the present study, higher rates of septic shock were seen in patients with versus without bacteremia.…”

Pulmonary Infection Is an Independent Risk Factor for Long-Term Mortality and Quality of Life for Sepsis Patients

“…Mansur et al's study [36] reported a higher 90-day mortality in pulmonary-sepsis than abdominal-sepsis. Kim et al [18] reported significantly higher 28 d mortality of pneumonia (41%) than non-pulmonary-sepsis (30%), and pneumonia was demonstrated to be a risk factor for 28-day mortality.…”