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Open Access 01-08-2020 | Septicemia | Systematic Review

Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis

Authors: Robby Markwart, Hiroki Saito, Thomas Harder, Sara Tomczyk, Alessandro Cassini, Carolin Fleischmann-Struzek, Felix Reichert, Tim Eckmanns, Benedetta Allegranzi

Published in: Intensive Care Medicine | Issue 8/2020

Abstract

Purpose

Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospital-acquired (HA) and ICU-acquired (ICU-A) sepsis.

Methods

We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed.

Results

Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low- and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17–31.8%, range 16–36.4%). In the ICU, 24.4% (95% CI 16.7–34.2%, range 10.3–42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3–59.3%, range 18.7–69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3–11.9, range 2–20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35–90.2, range 9.2–254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4–61.1%, range 30.1–64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies.

Conclusion

HA sepsis is of major public health importance, and the burden is particularly high in ICUs. There is an urgent need to improve the implementation of global and local infection prevention and management strategies to reduce its high burden among hospitalized patients.

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ESICM LIVES 2019 Berlin, Germany. 28 September–2 October 2019 (2019) Intensive care medicine experimental 7(Suppl 3):55. https://doi.org/10.1186/s40635-019-0265-y

Title: Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis
Authors: Robby Markwart
Hiroki Saito
Thomas Harder
Sara Tomczyk
Alessandro Cassini
Carolin Fleischmann-Struzek
Felix Reichert
Tim Eckmanns
Benedetta Allegranzi
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Septicemia
Septicemia
Neonatal Sepsis
Septic Shock
Care
Published in: Intensive Care Medicine / Issue 8/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06106-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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