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 2003-2004, 174 (30.53%) patients indeed fulfilled severe sepsis criteria of ACCPSCCM. The septic groups were compared with general ICU populations regarding demographic criteria, APACHE 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 II score (p<0.0006), SOFA score (p< O.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 were: pulmonary (57.47%), cardiac (47.13%), renal (34.48%), hepatic (34.48%), haematological (43.68%) and central nervous system (13.79%). Corresponding mortality rates were (70%, 68.29%, 40%, 53.3%, 50% and 58.33%) respectively. 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. |
