Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case-control study.
Attributable mortality
Epidemiology
Sepsis
Journal
Annals of intensive care
ISSN: 2110-5820
Titre abrégé: Ann Intensive Care
Pays: Germany
ID NLM: 101562873
Informations de publication
Date de publication:
26 Apr 2023
26 Apr 2023
Historique:
received:
09
01
2023
accepted:
24
03
2023
medline:
26
4
2023
pubmed:
26
4
2023
entrez:
26
4
2023
Statut:
epublish
Résumé
Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Matched 1:1 case-control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence. 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068-0.084) for medical admissions; 0.043 (95% CI 0.032-0.055) for elective surgical admissions; and 0.036 (95% CI 0.017-0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates. The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.
Sections du résumé
BACKGROUND
BACKGROUND
Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis.
METHODS
METHODS
Matched 1:1 case-control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence.
RESULTS
RESULTS
3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068-0.084) for medical admissions; 0.043 (95% CI 0.032-0.055) for elective surgical admissions; and 0.036 (95% CI 0.017-0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates.
CONCLUSION
CONCLUSIONS
The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.
Identifiants
pubmed: 37099045
doi: 10.1186/s13613-023-01123-y
pii: 10.1186/s13613-023-01123-y
pmc: PMC10133434
doi:
Types de publication
Journal Article
Langues
eng
Pagination
32Investigateurs
Barbara Macedo
(B)
Fabio S Coutinho
(FS)
Jussara A Arraes
(JA)
Viviane S N Xavier
(VSN)
Eliana V N Martins
(EVN)
Juliana Chaves Coelho
(JC)
Silvana S Santos
(SS)
Andreia Pardini
(A)
Cassio Luis Zandonai
(CL)
Julia B de Carvalho
(JB)
Isabela O B Louredo
(IOB)
Renata C Gonçalves
(RC)
Micheli C Arruda
(MC)
Mariana Regina da Cunha
(MR)
Mariana Bonomini F de Almeida
(MBF)
Juliano Ramos
(J)
Bruna M Binda
(BM)
Priscila L S Almeida
(PLS)
Marcia Maria R de Oliveira
(MMR)
Luciana S de Mattos
(LS)
Samara G da Silva
(SG)
Daniela C Dorta
(DC)
Martha Hadrich
(M)
Fernanda A F Gonçalves
(FAF)
Kaytiussia R de Sena
(KR)
Pamella M Dos Prazeres
(PM)
Josiane Festti
(J)
Informations de copyright
© 2023. The Author(s).
Références
Sci Rep. 2016 Dec 07;6:38361
pubmed: 27924831
Int J Epidemiol. 2017 Jun 1;46(3):1077-1079
pubmed: 28402483
Intensive Care Med. 2018 Sep;44(9):1512-1520
pubmed: 30105600
Lancet Infect Dis. 2020 Dec;20(12):e299-e306
pubmed: 32916101
Clin Infect Dis. 2020 Sep 12;71(6):1367-1376
pubmed: 31802125
Am J Epidemiol. 1974 May;99(5):325-32
pubmed: 4825599
Intensive Care Med. 2020 Aug;46(8):1536-1551
pubmed: 32591853
JAMA. 2016 Apr 12;315(14):1469-79
pubmed: 26975785
Lancet. 2020 Jan 18;395(10219):200-211
pubmed: 31954465
Biometrics. 1980 Jun;36(2):343-6
pubmed: 26625475
Biometrics. 2017 Sep;73(3):866-875
pubmed: 28099992
Am J Epidemiol. 1985 Nov;122(5):904-14
pubmed: 4050778
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Lancet Infect Dis. 2020 Feb;20(2):155-157
pubmed: 31753764
PLoS One. 2018 Nov 1;13(11):e0206610
pubmed: 30383864
Front Immunol. 2018 Oct 23;9:2446
pubmed: 30459764
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Intensive Care Med. 1996 Jul;22(7):707-10
pubmed: 8844239
Am J Epidemiol. 2021 Feb 1;190(2):318-321
pubmed: 32889542
Lancet Infect Dis. 2017 Nov;17(11):1180-1189
pubmed: 28826588
JAMA. 1994 May 25;271(20):1598-601
pubmed: 8182812
Stud Hist Philos Biol Biomed Sci. 2020 Oct;83:101291
pubmed: 32513474
Am J Respir Crit Care Med. 1999 Sep;160(3):976-81
pubmed: 10471627