Clinical and microbiological characterization of sepsis and evaluation of sepsis scores

TY - JOUR

T1 - Clinical and microbiological characterization of sepsis and evaluation of sepsis scores

AU - Fuchs, Andre

AU - Tufa, Tafese Beyene

AU - Hörner, Johannes

AU - Hurissa, Zewdu

AU - Nordmann, Tamara

AU - Bosselmann, Matthias

AU - Abdissa, Sileshi

AU - Sorsa, Abebe

AU - Orth, Hans Martin

AU - Jensen, Björn-Erik Ole

AU - MacKenzie, Colin

AU - Pfeffer, Klaus

AU - Kaasch, Achim J

AU - Bode, Johannes G

AU - Häussinger, Dieter

AU - Feldt, Torsten

PY - 2021

Y1 - 2021

N2 - BACKGROUND: Despite the necessity of early recognition for an optimal outcome, sepsis often remains unrecognized. Available tools for early recognition are rarely evaluated in low- and middle-income countries. In this study, we analyzed the spectrum, treatment and outcome of sepsis at an Ethiopian tertiary hospital and evaluated recommended sepsis scores.METHODS: Patients with an infection and ≥2 SIRS criteria were screened for sepsis by SOFA scoring. From septic patients, socioeconomic and clinical data as well as blood cultures were collected and they were followed until discharge or death; 28-day mortality was determined.RESULTS: In 170 patients with sepsis, the overall mortality rate was 29.4%. The recognition rate by treating physicians after initial clinical assessment was low (12.4%). Increased risk of mortality was significantly associated with level of SOFA and qSOFA score, Gram-negative bacteremia (in comparison to Gram-positive bacteremia; 42.9 versus 16.7%), and antimicrobial regimen including ceftriaxone (35.7% versus 19.2%) or metronidazole (43.8% versus 25.0%), but not with an increased respiratory rate (≥22/min) or decreased systolic blood pressure (≤100mmHg). In Gram-negative isolates, extended antimicrobial resistance with expression of extended-spectrum beta-lactamase and carbapenemase genes was common. Among adult patients, sensitivity and specificity of qSOFA score for detection of sepsis were 54.3% and 66.7%, respectively.CONCLUSION: Sepsis is commonly unrecognized and associated with high mortality, showing the need for reliable and easy-applicable tools to support early recognition. The established sepsis scores were either of limited applicability (SOFA) or, as in the case of qSOFA, were significantly impaired in their sensitivity and specificity, demonstrating the need for further evaluation and adaptation to local settings. Regional factors like malaria endemicity and HIV prevalence might influence the performance of different scores. Ineffective empirical treatment due to antimicrobial resistance is common and associated with mortality. Local antimicrobial resistance statistics are needed for guidance of calculated antimicrobial therapy to support reduction of sepsis mortality.

AB - BACKGROUND: Despite the necessity of early recognition for an optimal outcome, sepsis often remains unrecognized. Available tools for early recognition are rarely evaluated in low- and middle-income countries. In this study, we analyzed the spectrum, treatment and outcome of sepsis at an Ethiopian tertiary hospital and evaluated recommended sepsis scores.METHODS: Patients with an infection and ≥2 SIRS criteria were screened for sepsis by SOFA scoring. From septic patients, socioeconomic and clinical data as well as blood cultures were collected and they were followed until discharge or death; 28-day mortality was determined.RESULTS: In 170 patients with sepsis, the overall mortality rate was 29.4%. The recognition rate by treating physicians after initial clinical assessment was low (12.4%). Increased risk of mortality was significantly associated with level of SOFA and qSOFA score, Gram-negative bacteremia (in comparison to Gram-positive bacteremia; 42.9 versus 16.7%), and antimicrobial regimen including ceftriaxone (35.7% versus 19.2%) or metronidazole (43.8% versus 25.0%), but not with an increased respiratory rate (≥22/min) or decreased systolic blood pressure (≤100mmHg). In Gram-negative isolates, extended antimicrobial resistance with expression of extended-spectrum beta-lactamase and carbapenemase genes was common. Among adult patients, sensitivity and specificity of qSOFA score for detection of sepsis were 54.3% and 66.7%, respectively.CONCLUSION: Sepsis is commonly unrecognized and associated with high mortality, showing the need for reliable and easy-applicable tools to support early recognition. The established sepsis scores were either of limited applicability (SOFA) or, as in the case of qSOFA, were significantly impaired in their sensitivity and specificity, demonstrating the need for further evaluation and adaptation to local settings. Regional factors like malaria endemicity and HIV prevalence might influence the performance of different scores. Ineffective empirical treatment due to antimicrobial resistance is common and associated with mortality. Local antimicrobial resistance statistics are needed for guidance of calculated antimicrobial therapy to support reduction of sepsis mortality.

KW - Adolescent

KW - Adult

KW - Aged

KW - Anti-Bacterial Agents/therapeutic use

KW - Bacteria/classification

KW - Candida/drug effects

KW - Clindamycin/therapeutic use

KW - Cross-Sectional Studies

KW - Drug Resistance

KW - Ethiopia

KW - Female

KW - Hospital Mortality

KW - Humans

KW - Male

KW - Middle Aged

KW - Plasmodium/drug effects

KW - Prognosis

KW - Prospective Studies

KW - Sepsis/drug therapy

KW - Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use

KW - Young Adult

U2 - 10.1371/journal.pone.0247646

DO - 10.1371/journal.pone.0247646

M3 - SCORING: Journal article

C2 - 33661970

VL - 16

JO - PLOS ONE

JF - PLOS ONE

SN - 1932-6203

IS - 3

M1 - e0247646

ER -