Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis
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, Emb...
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| Veröffentlicht in: | Intensive care medicine 2020-08, Vol.46 (8), p.1536-1551 |
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| creator | Markwart, Robby Saito, Hiroki Harder, Thomas Tomczyk, Sara Cassini, Alessandro Fleischmann-Struzek, Carolin Reichert, Felix Eckmanns, Tim Allegranzi, Benedetta |
| description | 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. |
| doi_str_mv | 10.1007/s00134-020-06106-2 |
| format | Article |
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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.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-020-06106-2</identifier><identifier>PMID: 32591853</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Analysis ; Anesthesiology ; Bias ; Critical Care Medicine ; Cross Infection - epidemiology ; Emergency Medicine ; Epidemiology ; Health aspects ; Heterogeneity ; Hospital Mortality ; Hospitals ; Humans ; Incidence ; Infections ; Intensive ; Intensive care ; Intensive Care Units ; Length of Stay ; Medical colleges ; Medicine ; Medicine & Public Health ; Meta-analysis ; Neonates ; Nosocomial infections ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Public health ; Sepsis ; Sepsis - epidemiology ; Systematic Review</subject><ispartof>Intensive care medicine, 2020-08, Vol.46 (8), p.1536-1551</ispartof><rights>The Author(s) 2020</rights><rights>COPYRIGHT 2020 Springer</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c645t-af6a444def1600c30a3355f7ef7dc70a5ff7e3b7cb0a8ae9b063079d27919c5a3</citedby><cites>FETCH-LOGICAL-c645t-af6a444def1600c30a3355f7ef7dc70a5ff7e3b7cb0a8ae9b063079d27919c5a3</cites><orcidid>0000-0002-7038-1297</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-020-06106-2$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-020-06106-2$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32591853$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Markwart, Robby</creatorcontrib><creatorcontrib>Saito, Hiroki</creatorcontrib><creatorcontrib>Harder, Thomas</creatorcontrib><creatorcontrib>Tomczyk, Sara</creatorcontrib><creatorcontrib>Cassini, Alessandro</creatorcontrib><creatorcontrib>Fleischmann-Struzek, Carolin</creatorcontrib><creatorcontrib>Reichert, Felix</creatorcontrib><creatorcontrib>Eckmanns, Tim</creatorcontrib><creatorcontrib>Allegranzi, Benedetta</creatorcontrib><title>Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>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.</description><subject>Analysis</subject><subject>Anesthesiology</subject><subject>Bias</subject><subject>Critical Care Medicine</subject><subject>Cross Infection - epidemiology</subject><subject>Emergency Medicine</subject><subject>Epidemiology</subject><subject>Health aspects</subject><subject>Heterogeneity</subject><subject>Hospital Mortality</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infections</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Length of Stay</subject><subject>Medical colleges</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Neonates</subject><subject>Nosocomial infections</subject><subject>Pain Medicine</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Public health</subject><subject>Sepsis</subject><subject>Sepsis - epidemiology</subject><subject>Systematic Review</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kk1v1DAQhiMEokvhD3BAlrhwSfFnnHBAqqryIVXiAmdr4ky2rhJ7aydb7b_H2S0tRSvkgy3PM6_HM29RvGX0jFGqPyZKmZAl5bSkFaNVyZ8VKyYFLxkX9fNiRYXkpawkPylepXSTcV0p9rI4EVw1rFZiVdxdblyHowtDWO8I-I60c-zQk9CThJvkEgF7O7uIHXGeXIe0cRMMaY86P6FPbovEQkQyezelTwRI2qUJR5icJRG3Du_29IgTlOBh2GXV18WLPsvgm_v9tPj15fLnxbfy6sfX7xfnV6WtpJpK6CuQUnbYs4pSKygIoVSvsded1RRUn8-i1balUAM2La0E1U3HdcMaq0CcFp8Pupu5HbGz6KcIg9lEN0LcmQDOPI14d23WYWu0qJlUKgt8uBeI4XbGNJnRJYvDAB7DnAyXrGZc1oJm9P0_6E2YY_7wQvFKU6Ea_kitYUDjfB_yu3YRNeeai4YvY8pUeYRao8dcZPDYu3z9hD87wue1DNceTeCHBBtDShH7h54wahZ7mYO9TLaX2dvLLLW_-7ubDyl__JQBcQBSDvk1xscW_Ef2N1tb20Q</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Markwart, Robby</creator><creator>Saito, Hiroki</creator><creator>Harder, Thomas</creator><creator>Tomczyk, Sara</creator><creator>Cassini, Alessandro</creator><creator>Fleischmann-Struzek, Carolin</creator><creator>Reichert, Felix</creator><creator>Eckmanns, Tim</creator><creator>Allegranzi, Benedetta</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7038-1297</orcidid></search><sort><creationdate>20200801</creationdate><title>Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis</title><author>Markwart, Robby ; Saito, Hiroki ; Harder, Thomas ; Tomczyk, Sara ; Cassini, Alessandro ; Fleischmann-Struzek, Carolin ; Reichert, Felix ; Eckmanns, Tim ; Allegranzi, Benedetta</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c645t-af6a444def1600c30a3355f7ef7dc70a5ff7e3b7cb0a8ae9b063079d27919c5a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Analysis</topic><topic>Anesthesiology</topic><topic>Bias</topic><topic>Critical Care Medicine</topic><topic>Cross Infection - epidemiology</topic><topic>Emergency Medicine</topic><topic>Epidemiology</topic><topic>Health aspects</topic><topic>Heterogeneity</topic><topic>Hospital Mortality</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infections</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Length of Stay</topic><topic>Medical colleges</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Neonates</topic><topic>Nosocomial infections</topic><topic>Pain Medicine</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Public health</topic><topic>Sepsis</topic><topic>Sepsis - epidemiology</topic><topic>Systematic Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Markwart, Robby</creatorcontrib><creatorcontrib>Saito, Hiroki</creatorcontrib><creatorcontrib>Harder, Thomas</creatorcontrib><creatorcontrib>Tomczyk, Sara</creatorcontrib><creatorcontrib>Cassini, Alessandro</creatorcontrib><creatorcontrib>Fleischmann-Struzek, Carolin</creatorcontrib><creatorcontrib>Reichert, Felix</creatorcontrib><creatorcontrib>Eckmanns, Tim</creatorcontrib><creatorcontrib>Allegranzi, Benedetta</creatorcontrib><collection>Springer Nature OA/Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Markwart, Robby</au><au>Saito, Hiroki</au><au>Harder, Thomas</au><au>Tomczyk, Sara</au><au>Cassini, Alessandro</au><au>Fleischmann-Struzek, Carolin</au><au>Reichert, Felix</au><au>Eckmanns, Tim</au><au>Allegranzi, Benedetta</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>46</volume><issue>8</issue><spage>1536</spage><epage>1551</epage><pages>1536-1551</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32591853</pmid><doi>10.1007/s00134-020-06106-2</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0002-7038-1297</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Intensive care medicine, 2020-08, Vol.46 (8), p.1536-1551 |
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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Analysis Anesthesiology Bias Critical Care Medicine Cross Infection - epidemiology Emergency Medicine Epidemiology Health aspects Heterogeneity Hospital Mortality Hospitals Humans Incidence Infections Intensive Intensive care Intensive Care Units Length of Stay Medical colleges Medicine Medicine & Public Health Meta-analysis Neonates Nosocomial infections Pain Medicine Patients Pediatrics Pneumology/Respiratory System Public health Sepsis Sepsis - epidemiology Systematic Review |
| title | Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis |
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