Clinical and microbiological characterization of sepsis and evaluation of sepsis scores
Standard
Clinical and microbiological characterization of sepsis and evaluation of sepsis scores. / Fuchs, Andre; Tufa, Tafese Beyene; Hörner, Johannes; Hurissa, Zewdu; Nordmann, Tamara; Bosselmann, Matthias; Abdissa, Sileshi; Sorsa, Abebe; Orth, Hans Martin; Jensen, Björn-Erik Ole; MacKenzie, Colin; Pfeffer, Klaus; Kaasch, Achim J; Bode, Johannes G; Häussinger, Dieter; Feldt, Torsten.
In: PLOS ONE, Vol. 16, No. 3, e0247646, 2021.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
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 -