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Systematic Reviews

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Open Access 01-12-2015 | Protocol

Community-onset sepsis and its public health burden: protocol of a systematic review

Authors: Alexander Tsertsvadze, Pam Royle, Noel McCarthy

Published in: Systematic Reviews | Issue 1/2015

Abstract

Background

Sepsis is a life-threatening condition and major contributor of public health and economic burden in the industrialised world. The heterogeneity, absence of more specific definition, and difficulties in accurate diagnosis lead to great variability in the estimates of sepsis incidence. There has been uncertainty regarding the incidence and risk factors attributable to community-onset as opposed to hospital-acquired sepsis. Community-onset sepsis has distinct host characteristics, risk factors, pathogens, and prognosis. A systematic assessment of recent evidence is warranted in light of secular changes in epidemiology, pathogens, and the uncertainties around the incidence and risk factors of community-onset sepsis.

This protocol describes a systematic review which aims to synthesise the recent empirical evidence on the incidence and risk factors of community-onset sepsis, severe sepsis, and septic shock in high-income countries.

Methods/Design

English-language publications of cohort and case-control studies reporting incidence and risk factors of community-onset sepsis will be eligible for inclusion. MEDLINE and Embase databases will be searched from 2002 and onwards. References of relevant publications will be hand-searched. Two reviewers will independently screen titles/abstracts and full texts as well as extract data and appraise the risk of bias of included studies. The data extractions and risk of bias assessments will be cross-checked. Any disagreements will be resolved via consensus.

The data on incidence and risk factors of sepsis will be organised and synthesised in text, tables, and forest plots. The evidence will be pooled given sufficient data and degree of similarity across study populations, exposures, and outcomes. The heterogeneity will be assessed through visual inspection of forest plots, Chi-square-based p value, and I² statistic. The sources of heterogeneity will be explored via subgroup analysis.

Discussion

Timeliness and accuracy of diagnosis of sepsis are both crucial aspects for improving the patient’s outcome. The findings of this review will be discussed with a view to better inform future recommendations on improving public-facing campaigns, timely presentation, and diagnosis of sepsis in the community. The review will also discuss gaps in evidence and highlight future research and policy-making avenues for improving public health planning.

Systematic review registration

PROSPERO CRD42015023484

Available only for authorised users

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31(4):1250–6. doi:10.1097/01.CCM.0000050454.01978.3B.PubMedCrossRef

Moss M. Epidemiology of sepsis: race, sex, and chronic alcohol abuse. Clin Infect Dis. 2005;41 Suppl 7:S490–7. doi:10.1086/432003.PubMedCrossRef

Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.PubMedCrossRef

Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–54. doi:10.1056/NEJMoa022139.PubMedCrossRef

Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53.PubMedCrossRef

Daniels R. The incidence, mortality and economic burden of sepsis. NHS Evid Emerg & Urgent Care. 2009.

Jawad I, Luksic I, Rafnsson SB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health. 2012;2(1):010404. doi:10.7189/jogh.02.010404.PubMedPubMedCentralCrossRef

Fleischmann C, Scherag A, Adhikari N, Hartog C, Tsaganos T, Schlattmann P, et al. Global burden of sepsis: a systematic review. Crit Care. 2015;19 Suppl 1:21.CrossRef

Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K. Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med. 2003;31(9):2332–8. doi:10.1097/01.CCM.0000085141.75513.2B.PubMedCrossRef

10.

Brun-Buisson C, Meshaka P, Pinton P, Vallet B, Group ES. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004;30(4):580–8. doi:10.1007/s00134-003-2121-4.PubMedCrossRef

11.

Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med. 2004;30(4):589–96. doi:10.1007/s00134-004-2157-0.PubMedCrossRef

12.

Harrison DA, Welch CA, Eddleston JM. The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care. 2006;10(2):R42. doi:10.1186/cc4854.PubMedPubMedCentralCrossRef

13.

Karlsson S, Varpula M, Ruokonen E, Pettila V, Parviainen I, Ala-Kokko TI, et al. Incidence, treatment, and outcome of severe sepsis in ICU-treated adults in Finland: the Finnsepsis study. Intensive Care Med. 2007;33(3):435–43. doi:10.1007/s00134-006-0504-z.PubMedCrossRef

14.

Blanco J, Muriel-Bombin A, Sagredo V, Taboada F, Gandia F, Tamayo L, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care. 2008;12(6):R158. doi:10.1186/cc7157.PubMedPubMedCentralCrossRef

15.

Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41(5):1167–74. doi:10.1097/CCM.0b013e31827c09f8.PubMedCrossRef

16.

Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med. 2002;28(2):108–21. doi:10.1007/s00134-001-1143-z.PubMedCrossRef

17.

McPherson D, Griffiths C, Williams M, Baker A, Klodawski E, Jacobson B, et al. Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open. 2013;3(8), e002586. doi:10.1136/bmjopen-2013-002586.PubMedPubMedCentralCrossRef

18.

Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti-Infect Ther. 2012;10(6):701–6. doi:10.1586/eri.12.50.PubMedPubMedCentralCrossRef

19.

Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. NCHS Data Brief. 2011;62:1–8.PubMed

20.

Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med. 2014;42(3):625–31. doi:10.1097/CCM.0000000000000026.PubMedPubMedCentralCrossRef

21.

Cohen J, Vincent JL, Adhikari NK, Machado FR, Angus DC, Calandra T, et al. Sepsis: a roadmap for future research. Lancet Infect Dis. 2015;15(5):581–614. doi:10.1016/S1473-3099(15)70112-X.PubMedCrossRef

22.

Rhee C, Gohil S, Klompas M. Regulatory mandates for sepsis care—reasons for caution. N Engl J Med. 2014;370(18):1673–6. doi:10.1056/NEJMp1400276.PubMedPubMedCentralCrossRef

23.

Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311(13):1308–16. doi:10.1001/jama.2014.2637.PubMedCrossRef

24.

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55.PubMedCrossRef

25.

Vincent JL, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet. 2013;381(9868):774–5. doi:10.1016/S0140-6736(12)61815-7.PubMedPubMedCentralCrossRef

26.

Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: factors that influence disparities in sepsis. Crit Care Med. 2006;34(10):2576–82. doi:10.1097/01.CCM.0000239114.50519.0E.PubMedPubMedCentralCrossRef

27.

Barnato AE, Alexander SL, Linde-Zwirble WT, Angus DC. Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics. Am J Respir Crit Care Med. 2008;177(3):279–84. doi:10.1164/rccm.200703-480OC.PubMedCrossRef

28.

Mayr FB, Yende S, Linde-Zwirble WT, Peck-Palmer OM, Barnato AE, Weissfeld LA, et al. Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis. JAMA. 2010;303(24):2495–503. doi:10.1001/jama.2010.851.PubMedPubMedCentralCrossRef

29.

Wang HE, Shapiro NI, Griffin R, Safford MM, Judd S, Howard G. Chronic medical conditions and risk of sepsis. PLoS One. 2012;7(10), e48307. doi:10.1371/journal.pone.0048307.PubMedPubMedCentralCrossRef

30.

Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129(6):1432–40. doi:10.1378/chest.129.6.1432.PubMedCrossRef

31.

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128–40.PubMedCrossRef

32.

American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416. doi:10.1164/rccm.200405-644ST.CrossRef

33.

Wang HE, Addis DR, Donnelly JP, Shapiro NI, Griffin RL, Safford MM, et al. Discharge diagnoses versus medical record review in the identification of community-acquired sepsis. Crit Care. 2015;19(1):42. doi:10.1186/s13054-015-0771-6.PubMedPubMedCentralCrossRef

34.

Hoenigl M, Wagner J, Raggam RB, Prueller F, Prattes J, Eigl S, et al. Characteristics of hospital-acquired and community-onset blood stream infections, South-East Austria. PLoS One. 2014;9(8), e104702. doi:10.1371/journal.pone.0104702.PubMedPubMedCentralCrossRef

35.

Lenz R, Leal JR, Church DL, Gregson DB, Ross T, Laupland KB. The distinct category of healthcare associated bloodstream infections. BMC Infect Dis. 2012;12:85. doi:10.1186/1471-2334-12-85.PubMedPubMedCentralCrossRef

36.

Diekema DJ, Beekmann SE, Chapin KC, Morel KA, Munson E, Doern GV. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J Clin Microbiol. 2003;41(8):3655–60.PubMedPubMedCentralCrossRef

37.

Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care—associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002;137(10):791–7.PubMedCrossRef

38.

Siegman-Igra Y, Fourer B, Orni-Wasserlauf R, Golan Y, Noy A, Schwartz D, et al. Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia. Clin Infect Dis. 2002;34(11):1431–9. doi:10.1086/339809.PubMedCrossRef

39.

Cardoso T, Almeida M, Friedman ND, Aragao I, Costa-Pereira A, Sarmento AE, et al. Classification of healthcare-associated infection: a systematic review 10 years after the first proposal. BMC Med. 2014;12:40. doi:10.1186/1741-7015-12-40.PubMedPubMedCentralCrossRef

40.

Adrie C, Alberti C, Chaix-Couturier C, Azoulay E, De Lassence A, Cohen Y, et al. Epidemiology and economic evaluation of severe sepsis in France: age, severity, infection site, and place of acquisition (community, hospital, or intensive care unit) as determinants of workload and cost. J Crit Care. 2005;20(1):46–58.PubMedCrossRef

41.

Rodriguez-Bano J, Lopez-Prieto MD, Portillo MM, Retamar P, Natera C, Nuno E, et al. Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals. Clin Microbiol Infect. 2010;16(9):1408–13. doi:10.1111/j.1469-0691.2009.03089.x.PubMedCrossRef

42.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. doi:10.1186/2046-4053-4-1.PubMedPubMedCentralCrossRef

43.

Jolley RJ, Sawka KJ, Yergens DW, Quan H, Jette N, Doig CJ. Validity of administrative data in recording sepsis: a systematic review. Crit Care. 2015;19(1):139. doi:10.1186/s13054-015-0847-3.PubMedPubMedCentralCrossRef

44.

Balk RA. Severe sepsis and septic shock. Definitions, epidemiology, and clinical manifestations. Crit Care Clin. 2000;16(2):179–92.PubMedCrossRef

45.

Wang HE, Szychowski JM, Griffin R, Safford MM, Shapiro NI, Howard G. Long-term mortality after community-acquired sepsis: a longitudinal population-based cohort study. BMJ Open. 2014;4(1), e004283. doi:10.1136/bmjopen-2013-004283.PubMedPubMedCentralCrossRef

46.

Nygard ST, Langeland N, Flaatten HK, Fanebust R, Haugen O, Skrede S. Aetiology, antimicrobial therapy and outcome of patients with community acquired severe sepsis: a prospective study in a Norwegian university hospital. BMC Infect Dis. 2014;14:121. doi:10.1186/1471-2334-14-121.PubMedPubMedCentralCrossRef

47.

Henriksen DP, Pottegard A, Laursen CB, Jensen TG, Hallas J, Pedersen C, et al. Risk factors for hospitalization due to community-acquired sepsis—a population-based case-control study. PLoS One. 2015;10(4), e0124838. doi:10.1371/journal.pone.0124838.PubMedPubMedCentralCrossRef

48.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. W64.PubMedCrossRef

49.

Scottish Intercollegiate Guidelines Network. Checklist 3: cohort studies. In: SIGN 50: a guideline developer’s handbook, Edinburgh. 2008. http://www.sign.ac.uk/methodology/checklists.html. Accessed 01 September 2015.

50.

Scottish Intercollegiate Guidelines Network. Checklist 4: case-control studies. In: SIGN 50: a guideline developer’s handbook, Edinburgh. 2008. http://www.sign.ac.uk/methodology/checklists.html. Accessed 01 September 2015.

51.

Harder T, Takla A, Rehfuess E, Sanchez-Vivar A, Matysiak-Klose D, Eckmanns T, et al. Evidence-based decision-making in infectious diseases epidemiology, prevention and control: matching research questions to study designs and quality appraisal tools. BMC Med Res Methodol. 2014;14:69. doi:10.1186/1471-2288-14-69.PubMedPubMedCentralCrossRef

52.

Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. 510th ed. Chichester: Wiley Online Library; 2008.CrossRef

53.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.PubMedPubMedCentralCrossRef

54.

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. doi:10.1136/bmj.39489.470347.AD.PubMedPubMedCentralCrossRef

55.

Schunemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008;336(7653):1106–10. doi:10.1136/bmj.39500.677199.AE.PubMedPubMedCentralCrossRef

Title: Community-onset sepsis and its public health burden: protocol of a systematic review
Authors: Alexander Tsertsvadze
Pam Royle
Noel McCarthy
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Systematic Reviews / Issue 1/2015
Electronic ISSN: 2046-4053
DOI: https://doi.org/10.1186/s13643-015-0103-6

At a glance: The STEP trials

Springer Medicine

Community-onset sepsis and its public health burden: protocol of a systematic review

Abstract

Background

Methods/Design

Discussion

Systematic review registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods/Design

Discussion

Systematic review registration

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