Characteristics and prognosis factors of critically ill patients with community acquired infections
Keywords:
community-acquired infections, intensive care unit, prognostic factors, epidemiology, mortality.Abstract
Introduction: Patients with community-acquired infections require assistance in intensive care units.Objective: To identify characteristics and prognostic factors of critically ill patients with community-acquired infections.
Methods: A cohort study was carried out in 160 patients admitted to the intensive care unit for more than 48 hours. Variables age, sex, APACHE II index, SOFA scale, origin of the patients, stage of sepsis, comorbidity, location of the infection and therapeutic procedures were defined.
Results: 58.1% of the patients were women. The median age in deceased patients was 52.5 years and 39.9 years in living (p= 0.015). The mean APACHE II in deceased patients was 22.2 points (95% CI; 18.1-26.2) (p= 0.000). The frequency of immunosuppression, neutropenia and neoplasms (p< 0.05) showed differences between living and deceased; and pneumonia as location (46.7% vs. 17.9; p= 0.007). Intra-abdominal infection (40.0%), pneumonia (20.6%) and urinary tract infection (8.8%) represented the main locations of community acquired infections. In the binary logistic regression model, APACHE II (OR= 5.96; 95% CI: 1.02-34.8) and SOFA (OR= 5.68; 95% CI: 1.4-21.7) were prognostic factors.
Conclusions: The patients are characterized by being in their fourth decade, being female, having diabetes mellitus, immunosuppression or neoplasms and locations such as intra-abdominal infection and pneumonia mainly. APACHE II and SOFA are the prognostic factors for death.
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References
1. National Healthcare Safety Network. CDC/NHSN Surveillance Definitions for Specific Types of Infections. NHSN; 2021. [acceso: 28/06/2022]. Disponible en: https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf
2. Tonai M, Shiraishi A, Karumai T, Endo A, Yobayashi H, Fushimi K, et al. Hospital-onset sepsis and community-onset sepsis in critical care units in Japan: a retrospective cohort study based on a Japanese administrative claims database. Crit Care. 2022; 26(1):136. DOI10.1186/s13054-022-04013-0
3. Chen Y, Hu Y, Zhang J , Shen Y, Huang J, Yin J, et al. Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study. BMC Anesthesiol. 2019; 19(1):185. DOI: 10.1186/s12871-019-0849-9
4. Szabo BG, Kiss R, Lenart KS, Marosi B, Vad E, Lakatos B, et al. Clinical and microbiological characteristics and outcomes of community-acquired sepsis among adults: a single center, 1-year retrospective observational cohort study from Hungary. BMC Infect Dis. 2019; 19(1):584. DOI: 10.1186/s12879-019-4219-5
5. Lindström, AC, Eriksson M, Mårtensson J, Oldner A, Larsson E. Nationwide case-control study of risk factors and outcomes for community-acquired sepsis. Sci Rep. 2021; 11(1):15118. DOI: 10.1038/s41598-021-94558-x
6. Asensio MJ, Hernández M, Yus S, Minvielle A. Infecciones en el paciente crítico. Medicine (Madr). 2018; 12(52):3085-96. DOI: 10.1016/j.med.2018.03.014
7. Boeddha NP, Schlapbach LJ, Driessen JG, Herberg JA, Rivero-Calle I, Cebey-López, et al. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Crit Care. 2018; 22(1):143. DOI: 10.1186/s13054-018-2052-7
8. Park DW, Chun BC, Kim JM, Sohn JW, Peck KR, Kim YS, Choi YH,et al. Epidemiological and clinical characteristics of community-acquired severe sepsis and septic shock: a prospective observational study in 12 university hospitals in Korea. J Korean Med Sci. 2012; 27(11):1308-14. DOI: 10.3346/jkms.2012.27.11.1308
9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985 [acceso: 28/06/2022]; 13(10):818-29. Disponible en: https://www.researchgate.net/publication/19234189_APACHE_II_a_severity-_of_disease_classification_system
10. Vincent JL, Ferreira F, Moreno R. Scoring systems for assessing organ dysfunction and survival. Crit Care Clin. 2000; 16(2):353-66. DOI: 10.1016/s0749-0704(05)70114-7
11. 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 innovative therapies in sepsis. The ACCP/SCCM Consensus Conference of Chest Physicians/Society of Critical Care Medicine Chest. 1992; 101(6):1644-55. DOI: 10.1378/chest.101.6.1644
12. Singer M, Deutschman C, Seymour CW,Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. DOI: 10.1001/jama.2016.0287
13. Olaechea PM, Álvarez-Lerma F, Palomar M, Gimeno R, Gracia MP, Mas Net al . Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011). Med Intensiva. 2016; 40(4):216-29. DOI: 10.1016/j.medin.2015.07.003
14. Westphal GA, Pereira AB, Fachin SM, Barreto ACC, Bornschein ACGJ, Caldeira Filho M, et al. Characteristics and outcomes of patients with community-acquired and hospital-acquired sepsis. Rev Bras Ter Intensiva. 2019; 31(1):71-78. DOI: 10.5935/0103-507X.20190013
15. Hantrakun V, Somayaji R, Teparrukkul P, Boonsri C, Rudd K, Day NPJ, et al. Clinical epidemiology and outcomes of community acquired infection and sepsis among hospitalized patients in a resource limited setting in Northeast Thailand: A prospective observational study (Ubon-sepsis). PLoS ONE. 2018; 13(9): e0204509. DOI: 10.1371/journal.pone.0204509
16. González JC, Vázquez YE, Arias A, Cabrera JO. Características de la población atendida en una unidad de cuidados intensivos cubana: estudio del proyecto DINUCIs. Medisur. 2020 [acceso: 28/06/2022]; 18(5): [aprox. 10 p.]. Disponible en: http://medisur.sld.cu/index.php/medisur/article/view/4482
17. Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther. 2021; 217:107663. DOI: 10.1016/j.pharmthera.2020.107663
18. Todorovic Markovic M, Pedersen C, Gottfredsson M, Todorovic Mitic M, Gaini S. Epidemiology of community-acquired sepsis in the Faroe Islands - a prospective observational study. Infect Dis (Lond). 2019; 51(1):38-49. DOI: 10.1080/23744235.2018.1511056
19. Dabar G, Harmouche C, Salameh P, Jaber BL, Jamaleddine G, Waked M, et al. Community-and healthcare-associated infections in critically ill patients: a multicenter cohort study. Int J Infect Dis. 2015; 37: 80-5. DOI: 10.1016/j.ijid.2015.05.024
20. Abdo A, Castellanos R. Incidencia de infecciones relacionadas con el cuidado sanitario en unidades de cuidados intensivos en Cuba: año 2015 e informe de tendencias del primer quinquenio. Investigaciones Medicoquirúrgicas. 2017 [acceso: 28/06/2022]; 9(1): [aprox. 28 p.]. Disponible en: http://www.revcimeq.sld.cu/index.php/imq/article/view/374
21. Grozdanovski K, Milenkovic Z, Demiri I, Spasovska K. Prediction of Outcome from Community-Acquired Severe Sepsis and Septic Shock in Tertiary-Care University Hospital in a Developing Country. Crit Care Res Pract. 2012; 2012: 182324. DOI: 10.1155/2012/182324
22. Zhang MQ, Macala KF, Fox-Robichaud A, Mendelson AA, Lalu MM, Sepsis Canada National Preclinical Sepsis Platform Sex- and Gender-Dependent Differences in Clinical and Preclinical Sepsis. Shock. 2021; 56(2):178-87. DOI: 10.1097/SHK.0000000000001717
23. Sunden-Cullberg J, Nilsson A, Inghammar M. Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study. Intensive Care Med. 2020; 46(4):727-36. DOI: 10.1007/s00134-019-05910-9
24. Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU - APACHE II, SOFA or SAP II!. Pak J Med. Sci. 2016; 32(5):1146-51. DOI: 10.12669/pjms.325.10080
25. Blot S, Antonelli M, Arvaniti K, Blot K, Creagh-Brown B, de Lange D, et al. Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project. Intensive Care Med. 2019; 45(12):1703-17. DOI: 10.1007/s00134-019-05819-3
2. Tonai M, Shiraishi A, Karumai T, Endo A, Yobayashi H, Fushimi K, et al. Hospital-onset sepsis and community-onset sepsis in critical care units in Japan: a retrospective cohort study based on a Japanese administrative claims database. Crit Care. 2022; 26(1):136. DOI10.1186/s13054-022-04013-0
3. Chen Y, Hu Y, Zhang J , Shen Y, Huang J, Yin J, et al. Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study. BMC Anesthesiol. 2019; 19(1):185. DOI: 10.1186/s12871-019-0849-9
4. Szabo BG, Kiss R, Lenart KS, Marosi B, Vad E, Lakatos B, et al. Clinical and microbiological characteristics and outcomes of community-acquired sepsis among adults: a single center, 1-year retrospective observational cohort study from Hungary. BMC Infect Dis. 2019; 19(1):584. DOI: 10.1186/s12879-019-4219-5
5. Lindström, AC, Eriksson M, Mårtensson J, Oldner A, Larsson E. Nationwide case-control study of risk factors and outcomes for community-acquired sepsis. Sci Rep. 2021; 11(1):15118. DOI: 10.1038/s41598-021-94558-x
6. Asensio MJ, Hernández M, Yus S, Minvielle A. Infecciones en el paciente crítico. Medicine (Madr). 2018; 12(52):3085-96. DOI: 10.1016/j.med.2018.03.014
7. Boeddha NP, Schlapbach LJ, Driessen JG, Herberg JA, Rivero-Calle I, Cebey-López, et al. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Crit Care. 2018; 22(1):143. DOI: 10.1186/s13054-018-2052-7
8. Park DW, Chun BC, Kim JM, Sohn JW, Peck KR, Kim YS, Choi YH,et al. Epidemiological and clinical characteristics of community-acquired severe sepsis and septic shock: a prospective observational study in 12 university hospitals in Korea. J Korean Med Sci. 2012; 27(11):1308-14. DOI: 10.3346/jkms.2012.27.11.1308
9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985 [acceso: 28/06/2022]; 13(10):818-29. Disponible en: https://www.researchgate.net/publication/19234189_APACHE_II_a_severity-_of_disease_classification_system
10. Vincent JL, Ferreira F, Moreno R. Scoring systems for assessing organ dysfunction and survival. Crit Care Clin. 2000; 16(2):353-66. DOI: 10.1016/s0749-0704(05)70114-7
11. 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 innovative therapies in sepsis. The ACCP/SCCM Consensus Conference of Chest Physicians/Society of Critical Care Medicine Chest. 1992; 101(6):1644-55. DOI: 10.1378/chest.101.6.1644
12. Singer M, Deutschman C, Seymour CW,Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. DOI: 10.1001/jama.2016.0287
13. Olaechea PM, Álvarez-Lerma F, Palomar M, Gimeno R, Gracia MP, Mas Net al . Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011). Med Intensiva. 2016; 40(4):216-29. DOI: 10.1016/j.medin.2015.07.003
14. Westphal GA, Pereira AB, Fachin SM, Barreto ACC, Bornschein ACGJ, Caldeira Filho M, et al. Characteristics and outcomes of patients with community-acquired and hospital-acquired sepsis. Rev Bras Ter Intensiva. 2019; 31(1):71-78. DOI: 10.5935/0103-507X.20190013
15. Hantrakun V, Somayaji R, Teparrukkul P, Boonsri C, Rudd K, Day NPJ, et al. Clinical epidemiology and outcomes of community acquired infection and sepsis among hospitalized patients in a resource limited setting in Northeast Thailand: A prospective observational study (Ubon-sepsis). PLoS ONE. 2018; 13(9): e0204509. DOI: 10.1371/journal.pone.0204509
16. González JC, Vázquez YE, Arias A, Cabrera JO. Características de la población atendida en una unidad de cuidados intensivos cubana: estudio del proyecto DINUCIs. Medisur. 2020 [acceso: 28/06/2022]; 18(5): [aprox. 10 p.]. Disponible en: http://medisur.sld.cu/index.php/medisur/article/view/4482
17. Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther. 2021; 217:107663. DOI: 10.1016/j.pharmthera.2020.107663
18. Todorovic Markovic M, Pedersen C, Gottfredsson M, Todorovic Mitic M, Gaini S. Epidemiology of community-acquired sepsis in the Faroe Islands - a prospective observational study. Infect Dis (Lond). 2019; 51(1):38-49. DOI: 10.1080/23744235.2018.1511056
19. Dabar G, Harmouche C, Salameh P, Jaber BL, Jamaleddine G, Waked M, et al. Community-and healthcare-associated infections in critically ill patients: a multicenter cohort study. Int J Infect Dis. 2015; 37: 80-5. DOI: 10.1016/j.ijid.2015.05.024
20. Abdo A, Castellanos R. Incidencia de infecciones relacionadas con el cuidado sanitario en unidades de cuidados intensivos en Cuba: año 2015 e informe de tendencias del primer quinquenio. Investigaciones Medicoquirúrgicas. 2017 [acceso: 28/06/2022]; 9(1): [aprox. 28 p.]. Disponible en: http://www.revcimeq.sld.cu/index.php/imq/article/view/374
21. Grozdanovski K, Milenkovic Z, Demiri I, Spasovska K. Prediction of Outcome from Community-Acquired Severe Sepsis and Septic Shock in Tertiary-Care University Hospital in a Developing Country. Crit Care Res Pract. 2012; 2012: 182324. DOI: 10.1155/2012/182324
22. Zhang MQ, Macala KF, Fox-Robichaud A, Mendelson AA, Lalu MM, Sepsis Canada National Preclinical Sepsis Platform Sex- and Gender-Dependent Differences in Clinical and Preclinical Sepsis. Shock. 2021; 56(2):178-87. DOI: 10.1097/SHK.0000000000001717
23. Sunden-Cullberg J, Nilsson A, Inghammar M. Sex-based differences in ED management of critically ill patients with sepsis: a nationwide cohort study. Intensive Care Med. 2020; 46(4):727-36. DOI: 10.1007/s00134-019-05910-9
24. Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A. Better prognostic marker in ICU - APACHE II, SOFA or SAP II!. Pak J Med. Sci. 2016; 32(5):1146-51. DOI: 10.12669/pjms.325.10080
25. Blot S, Antonelli M, Arvaniti K, Blot K, Creagh-Brown B, de Lange D, et al. Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project. Intensive Care Med. 2019; 45(12):1703-17. DOI: 10.1007/s00134-019-05819-3
Published
2022-11-12
How to Cite
1.
González Aguilera JC, Cabrera Lavernia JO, Vazquez Belizon YE, Arias Ortiz A, Sánchez Figueredo SA. Characteristics and prognosis factors of critically ill patients with community acquired infections. Rev Cubana Med Milit [Internet]. 2022 Nov. 12 [cited 2025 Apr. 19];51(4):e02202229. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/2229
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