The frequency and circumstances of sepsis in patients admitted to the intensive care unit

CILJ ISTRAŽIVANJA: Utvrditi učestalost i okolnosti nastanka sepse kod kritično oboljelih pacijenata zbrinjavanih u JIL-u te procijeniti težinu sepse na temelju stupnja poremećenosti funkcije vitalnih organa. NACRT STUDIJE: Retrospektivna studija. ISPITANICI I METODE: Ispitanici su odrasli bolesnici liječeni u JIL-u KBC-a Osijek u dvogodišnjem razdoblju. Demografski i klinički podatci o ispitanicima prikupljeni su iz povijesti bolesti, a podatci o uzročnim patogenima iz mikrobiološkog protokola. REZULTATI: Sepsa je utvrđena kod 99 ispitanika. Kod 62 ispitanika utvrđena je u trenutku prijema, dok se kod 44 ispitanika javila tijekom boravka u JIL-u. Kod najvećeg broja ispitanika došlo je do disfunkcija dišnog sustava. Većina ispitanika bili su kirurški bolesnici. Izvor sepse u 39 % slučajeva bila je intraabdominalna infekcija, a u 30 % slučajeva respiratorna infekcija. Uzročnici su u 58 % slučajeva bili rezistentni bolnički mikroorganizmi. Umrlo je 70 % ispitanika s potvrđenom sepsom. Prema kriterijima nove definicije sepsa je utvrđena kod 58 % ispitanika. Nije utvrđena razlika u vrijednosti SOFA skora između „septičnih“ i „neseptičnih“ ispitanika, ali su potonji imali povoljniji ishod liječenja. ZAKLJUČAK: Kirurška bolest i potreba za hitnim operativnim liječenjem važni su čimbenici rizika za nastanak sepse očigledne kod prijema u JIL. Ishodišta sepse su intraabdominalne i respiratorne infekcije, a uzročnici često rezistentni bolnički mikroorganizmi. Prema kriterijima nove definicije, izdvojeni su septični bolesnici sa slikom teške sepse i septičkog šoka. Ispitanici u kojih nije potvrđena sepsa imali su povoljniji ishod liječenja.OBJECTIVES: The aim of this study was to determine the frequency and circumstances of the occurrence of sepsis in critical patients treated at the Intensive care unit and to evaluate the severity of sepsis due to the degree of the damage of the function of vital organs. SUDY DESIGN: Retrospective study. PARTICIPANTS AND METHODS: The respondents were adult patients treated at the Intensive care unit at Clinical Hospital Center Osijek over a period of two years. Demographic and clinical data on the respondents were collected from the respondents’ medical history and data on pathogens were taken from the microbiological protocol. RESULTS: Sepsis was found in 99 respondents. In 62 respondents, it was established at the time of admission, while in 44 respondents it was found during their stay at the Intensive care unit. The majority of the respondents reported the dysfunction of the respiratory system. Most of the respondents were surgical patients. In 39 % of cases sepsis source were intraabdominal infections, and in 30 % of cases source were respiratory infections. In 58 % of cases the causes of sepsis were resistant hospital microorganisms. 70 % of the respondents with confirmed sepsis died. When the new critera were taken into concideration, sepsis was found in 58 % of the respondents. Statistically significant difference was not found in SOFA score between "septic" and "non-septic" respondents, but the latter had more favorable outcome of the treatment. CONCLUSION: Surgical treatment and emergency operation are key risk factors for sepsis on the admission to the Intensive care unit. Sepsis outbreaks are most common in intraabdominal and respiratory infections, while pathogens are often resistant hospital microorganisms. Septic patients with severe sepsis and septic shock were isolated according to the new definition of sepsis criteria. Subjects without confirmed sepsis had more favorable outcome of the treatment