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Care Improved by Information on Patients Most Likely to Develop Sepsis

ATLANTA – Which patients are most likely to develop sepsis?

Knowing the answer to that question could aid in prevention, early recognition, and more effective treatment strategies, according to a new study published in the Morbidity & Mortality Weekly Report, which details patient demographics, risk factors, and infections leading to sepsis.

To better describe characteristics of patients with sepsis, researchers from the national Centers for Disease Control and Prevention and co-authors conducted a retrospective chart review in four New York hospitals, reviewing random samples of medical records from adult and pediatric patients with administrative codes for severe sepsis or septic shock. Overall, medical records of 246 adults and 79 children up to age 17 were reviewed.

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Results indicate that 72% of patients had healthcare involvement during the 30 days before sepsis admission or a selected chronic condition requiring frequent medical care. The most common infection leading to sepsis was pneumonia, with Escherichia coli in adults, Klebsiella spp. in children 1 year of age or older, and Enterococcus spp. in infants younger than 1 year of age being the most common pathogens isolated from blood cultures. No pathogen was isolated for 33% of the patients, according to the report.

A fourth of the patients died, including 26% of adults and 22% of infants and children, study authors report.

The median age of adult patients with sepsis was 69 years and 52% were male, according to the study, which found that the median length of hospital stay was nine days. Most patients, 97%, had at least one comorbidity, most commonly diabetes mellitus, 35%; cardiovascular disease (including coronary artery disease, peripheral vascular disease, or congestive heart failure), 32%; chronic kidney disease, 23%; and chronic obstructive pulmonary disease, 23%.

After pneumonia, which was identified in 35% of sepsis patients, urinary tract infections 25%; gastrointestinal infections, 11%, and skin/soft tissue infections, 11%, were most likely to be the precipitating infections, according to the results.

The majority of cases among adults, 58%, were identified as healthcare-associated, with 18% of those hospital-onset and 42% classified as community-associated, without healthcare factors. Acute care hospitalization or nursing home stays of two or more days in the preceding 30 days were the most common experiences leading to development of sepsis, the study notes.

Another issue, according to the researchers, is that only 44% of sepsis patients had received pneumococcal vaccination in the preceding year and 35% had received a flu shot.

For pediatric patients, at least one comorbidity was present for 78% of sepsis patients, with congenital heart disease being the most common condition for infants, affecting 23% of patients, and cognitive deficits or cerebral palsy being most common for children, 38%.

Children who developed sepsis were most likely to have respiratory infections, 29%, followed by gastrointestinal infections, 24%, according to the results.