[Source: PLOS One, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study
Eric H. Chou, Shaynna Mann, Tzu-Chun Hsu, Wan-Ting Hsu, Carolyn Chia-Yu Liu, Toral Bhakta, Dahlia M. Hassani, Chien-Chang Lee
Published: January 13, 2020 / DOI: https://doi.org/10.1371/journal.pone.0227752
To determine the trends of infection sites and outcome of sepsis using a national population-based database.
Materials and methods
Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality.
During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%).
The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.
Citation: Chou EH, Mann S, Hsu T-C, Hsu W-T, Liu CC-Y, Bhakta T, et al. (2020) Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study. PLoS ONE 15(1): e0227752. https://doi.org/10.1371/journal.pone.0227752
Editor: Florian B. Mayr, University of Pittsburgh, UNITED STATES
Received: June 5, 2019; Accepted: December 27, 2019; Published: January 13, 2020
Copyright: © 2020 Chou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Keywords: Sepsis; USA.