Incidence and Outcome of Severe Sepsis in Critically Ill Patients
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Objective: Sepsis is an emergent public health problem. Severe sepsis and septic shock are life threatening complications of infections with a high incidence and mortality rates. Death is strongly related to types and number of systems failure, beside other risk factors. The aim of this work is to identify the incidence of severe sepsis and septic shock, mortality rate, and its relation to risk factors as age and types of organs failure, and to identify the most prevalent causative bacteria. Patients and Methods: Retrospective evaluation was done for 570 patients admitted to 3 general Intensive Care Units (ICUs) during 2005-2006, 174 (30.53%) patients indeed fulfilled severe sepsis criteria of ACCP\SCCM. The septic groups were compared with general ICU populations regarding demographic criteria, APACIIE II, SOFA scores and mortality rates. The septic groups were severe sepsis (16.14%) and septic shock (14.38%) and they were compared with each other as regard the previous criteria. Septic shock was also compared with a non septic shock group. Results: The whole septic group patients were older, with significantly higher APACHE II (p<0.0001), SOFA score (p< 0.0001), and mortality rates (p<0.05) compared to the general ICU population. Patients with septic shock had significantly higher age, APACHE H score (p<0.0006), INTRODUCTION A lack of widely accepted definitions of severe sepsis and septic shock has made it difficult to obtain accurate estimates of their frequency. Awareness of the seriousness of this condition remains low; severe sepsis is frequently under-diagnosed at an early stage when it is still potentially reversible. Epidemiologic data indicate that there are more than 750,000 cases of sepsis per year in USA with an attributable mortality of more * Chest Diseases, ** Public Health, *0* Tropical Medicine. **** Anesthesia and Intensive Care, and *42*** Internal Medicine. Banha and Minia. Faculty of Medicine. Zagazig and Minia Universities and Banha Teaching Hospital. Egypt SOFA score (p< 0.0001), and a higher mortality rate (68.29 % versus 28.26%) compared to those with severe sepsis group. Moreover, nonsurvivors were higher than survivors with a mortality rate reaching 80% in age groups older than 65 years. The prevalences of monomicrobial, multimicrobial, and culture negative sepsis were (32.75%, 36.78% and 30.45%) respectively among the studied cases with sepsis. Gram positive organisms constituted about one third of positive cultures. Infection of respiratory tract was the most predominant (47.7%), and bacteraemia was detectable in (18.96%) of cases. The prevalence of acute organs failure was: pulmonary (57.47%), cardiac (47.13%), renal (34.48%), hepatic (34.48%), hematological (43.68%) and central nervous system (13.79%). Corresponding mortality rates were (70%, 68.29%, 40%, 53.3%, 50% and 58.33%) respect ively. In comparison with non-septic shock patients, septic shock group still more likely to have significantly higher mean SOFA score and a higher mortality rate. Conclusion: The incidence rate of severe sepsis & septic shock in our study was (30.53%) with (47.13%) mortality. A gram positive infection was evident in about one third of our studied septic cases. Mortality increases significantly with age, APACHE II and SOFA scores. Septic shock appears to be associated with poor outcome.