The Treatment Outcome of Community-Acquired Sepsis in Chonburi Hospital
บทคัดย่อ
Community-acquired sepsis is a serious condition with high mortality rate worldwide. Efforts had been put to improve treatment outcome of such condition. In 2016, the Sepsis-3 definition was developed and then the new sepsis care bundle with 5 elements in 2018 which also implemented in Chonburi hospital. In Thailand, Ministry of Public Health set target to decrease mortality rate to below 30%. However, published clinical trials using Sepsis-3 definition and sepsis care bundle to evaluate treatment outcome in Thailand were scarce. We retrospectively enrolled patients with community-acquired sepsis defined by Sepsis-3 who were admitted to medicine ward, Chonburi hospital. Medical charts were reviewed, clinical data were recorded and analyzed.
Between April 1st and May 31st, 2018, a total of 112 patients with confirmed diagnosis of community-acquired sepsis were enrolled. The mortality rate was 42% (95% CI 32.7-51.7). Bacteremia was found in 52.7% (95% CI 43.0-62.2) of patients and 32.2% (95% CI 20.6-45.6) of them had antimicrobial resistant bacterial infection. Compliance to sepsis care bundle was over 80% except for intravenous fluid resuscitation which complied 48.8% (95% CI 37.6-60.1). Overall, fully compliance rate was 44.6% (95% CI 35.2-54.3). Complete all elements of sepsis care bundle was the only factor associated with decrease mortality with statistical significance, odds ratio 2.926 (95% CI 1.32-6.47: P-value = 0.008).
In summary, the hospital mortality rate of community-acquired sepsis patients admitted to medicine ward, Chonburi hospital was higher than targeted. Improvement of sepsis car bundle compliance is critical to decrease mortality rate.
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Carolin F, André S, Neill KJA, Christiane SH, Thomas T. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med 2016;193(3):259-72.
Fleischmann C, Thomas-Rueddel DO, Hartmann M, Hartog CS, Welte T, Heublein S, et al. Hospital incidence and mortality rates of sepsis. Dtsch Arztebl Int 2016;113(10):159-66.
Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM. Population burden of long-term survivorship after severe sepsis in older Americans. J Am Geriatr Soc 2012;60(6):1070-7.
Cheng AC, West TE, Limmathurotsakul D, Peacock SJ. Strategies to reduce mortality from bacterial sepsis in adults in developing countries. PLoS Med 2008;5(8):e175.
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.
Angkasekwinai N, Rattanaumpawan P, Thamlikitkul V. Epidemiology of sepsis in Siriraj hospital 2007. J Med Assoc Thai 2009;92(Suppl 2):S68-78.
Khwannimit B, Bhurayanontachai R. The epidemiology of and risk factors for mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect 2009;137(9):1333-41.
Chuesakoolvanich K. Septic death in adults at Surin hospital: an investigation of real-life clinical practice vs. Empirical guidelines. J Med Assoc Thai 2007;90(10):2039-46.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801-10.
Dellinger R, Levy M, Rhodes A, Annane D, Gerlach H, Opal S, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580-637.
Kathryn M, Rowan KM, Angus DC, Bailey M, Barnato AE, Bellomo R, et al. Early, goal-directed therapy for septic shock - a patient-level meta-analysis. N Engl J Med 2017;376(23):2223-34.
Nguyen HB, Jaehne AK, Jayaprakash N, Semler MW, Hegab S, Yataco AC, et al. Early goal-directed therapy in severe sepsis and septic shock: insights and comparisons to process, promise, and arise. Crit Care 2016;20(1):160.
Howell MD, Davis AM. Management of sepsis and septic shock. JAMA 2017;317(8):847-8.
Jirajariyavej S, So-Ngern A, Tantawichien T, Soomhirun R. Outcomes of clinical practice guideline for sepsis patients in Taksin hospital. J Med Assoc Thai 2018;101:1115-20.
Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):762-74.
Raith EP, Udy AA, Bailey M, Mcgloughlin S, Macisaac C, Bellomo R, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA 2017;317(3):290-300.
Freund Y, Lemachatti N, Krastinova E, Van Laer M, Claessens YE, Avondo A, et al. Prognostic accuracy of sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 2017;317(3):301-8.
Jones AE, Trzeciak S, Kline JA. The sequential organ failure assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Crit Care Med 2009;37(5):1649-54.
Pandharipande PP, Sanders N, St Jacques P, Ely EW, Shintani A. Calculating SOFA scores when arterial blood gasses are not available: validating SpO2/FiO2 ratios for imputing PaO2/FiO2 ratios in the SOFA scores. Cri Care Med 2006;34(12):A 1.
Ramsdell TH, Smith AN, Kerkhove E. Compliance with updated sepsis bundles to meet new sepsis core measure in a tertiary care hospital. Hosp Pharm 2017;52(3):177-86.
Khamsarn S, Nampoonsak Y, Busamaro S, Tangkoskul T, Seenama C, Rattanaumpawan P, et al. Epidemiology of antibiotic use and antimicrobial resistance in selected communities in Thailand. J Med Assoc Thai 2016;99(3):270-5.
Prasertsiriphong S, Chootong R, Jamulitrat S, Phengmak M. Prevalence of antibiotic resistance in Escherichia coli from the fecal flora of humans in a rural area of Songkhla province. Journal of Health Science and Medical Research 2019;37(4):7.
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