The Epidemiology of Sepsis

Chapter

Abstract

  • The global burden of sepsis is estimated at 19.4 million cases each year and 5.3 million sepsis-related deaths annually. However, this estimate is based on the incidence of hospital-treated sepsis in the developed world and may underestimate the true global burden of sepsis.

  • The incidence of sepsis is rising over time, and there are disparities in incidence by age, gender, comorbidity burden, and socioeconomic status.

  • The most common sites of infection are the lung, abdomen, urinary tract, bloodstream, and skin/soft tissue.

  • About 35–45% of sepsis cases have gram-negative organisms identified, 30–40% have gram-positive organisms identified, and 12–16% have fungal organisms identified. Thirty to forty percent of cases are culture negative, and 20% have multiple pathogens identified.

  • The case-fatality rate is falling, but sepsis survivors are at increased risk for morbidity, recurrent sepsis, and late death.

  • Thirty to forty percent of sepsis survivors are rehospitalized within 90 days, most commonly for recurrent sepsis.

Keywords

Incidence Case-fatality rate Site Pathogen Organ failure Disparities Comorbid conditions Long-term outcomes Recurrent sepsis 

References

  1. 1.
    Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801–10.CrossRefGoogle Scholar
  2. 2.
    Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29:530–8.CrossRefGoogle Scholar
  3. 3.
    Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest. 1992;101:1481–3.CrossRefGoogle Scholar
  4. 4.
    Murray CJL, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet Lond Engl. 2012;380:2197–223.CrossRefGoogle Scholar
  5. 5.
    Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet Lond Engl. 2012;380:2095–128.CrossRefGoogle Scholar
  6. 6.
    Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, Angus DC, Reinhart K, International Forum of Acute Care Trialists. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med. 2016;193:259–72.CrossRefGoogle Scholar
  7. 7.
    SEER cancer stat facts. https://seer.cancer.gov/statfacts/. Accessed 13 Jul 2017.
  8. 8.
    Torio C, Moore BJ. National Inpatient Hospital Costs: the most expensive hospital conditions by payer, 2013. HCUP statistical brief #204. Rockville, MD: Agency for Healthcare Research and Quality; 2016. https://hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.pdf. Accessed 14 Feb 2017Google Scholar
  9. 9.
    Szakmany T, Lundin RM, Sharif B, et al. Sepsis prevalence and outcome on the general wards and emergency departments in Wales: results of a Multi-Centre, Observational, Point Prevalence Study. PLoS One. 2016;11:e0167230.CrossRefGoogle Scholar
  10. 10.
    Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34:344–53.CrossRefGoogle Scholar
  11. 11.
    Zhou J, Qian C, Zhao M, et al. Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS One. 2014;9:e107181.CrossRefGoogle Scholar
  12. 12.
    Harrison DA, Welch CA, Eddleston JM. The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care Lond Engl. 2006;10:R42.CrossRefGoogle Scholar
  13. 13.
    Weiss SL, Fitzgerald JC, Pappachan J, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015;191:1147–57.CrossRefGoogle Scholar
  14. 14.
    Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, Iwashyna TJ. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312:90–2.CrossRefGoogle Scholar
  15. 15.
    Reinhart K, Daniels R, Kissoon N, Machado FR, Schachter RD, Finfer S. Recognizing sepsis as a global health priority – a WHO resolution. N Engl J Med. 2017;377:414–7.  https://doi.org/10.1056/NEJMp1707170.CrossRefPubMedGoogle Scholar
  16. 16.
    Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–10.CrossRefGoogle Scholar
  17. 17.
    HCUPnet, Healthcare Cost and Utilization Project. Agency for healthcare research and quality. Rockville, MD. http://hcupnet.ahrq.gov/. Accessed 23 Nov 2016.
  18. 18.
    Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–16.CrossRefGoogle Scholar
  19. 19.
    Prescott HC, Kepreos KM, Wiitala WL, Iwashyna TJ. Temporal changes in the influence of hospitals and regional healthcare networks on severe sepsis mortality. Crit Care Med. 2015;43:1368–74.CrossRefGoogle Scholar
  20. 20.
    Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med. 2014;42:625–31.CrossRefGoogle Scholar
  21. 21.
    Lindenauer PK, Lagu T, Shieh MS, Pekow PS, Rothberg MB. Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003–2009. JAMA. 2012;307:1405–13.CrossRefGoogle Scholar
  22. 22.
    Will Rogers phenomenon. Wikipedia; 2017.Google Scholar
  23. 23.
    Iwashyna TJ, Angus DC. Declining case fatality rates for severe sepsis: good data bring good news with ambiguous implications. JAMA. 2014;311:1295–7.CrossRefGoogle Scholar
  24. 24.
    Kadri SS, Rhee C, Strich JR, Morales MK, Hohmann S, Menchaca J, Suffredini AF, Danner RL, Klompas M. Estimating ten-year trends in septic shock incidence and mortality in United States academic medical centers using clinical data. Chest. 2017;151:278–85.CrossRefGoogle Scholar
  25. 25.
    Danai PA, Sinha S, Moss M, Haber MJ, Martin GS. Seasonal variation in the epidemiology of sepsis. Crit Care Med. 2007;35:410–5.CrossRefGoogle Scholar
  26. 26.
    Sakhuja A, Nanchal RS, Gupta S, Amer H, Kumar G, Albright RC, Kashani KB. Trends and outcomes of severe sepsis in patients on maintenance dialysis. Am J Nephrol. 2016;43:97–103.CrossRefGoogle Scholar
  27. 27.
    Williams MD, Braun LA, Cooper LM, Johnston J, Weiss RV, Qualy RL, Linde-Zwirble W. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care Lond Engl. 2004;8:R291–8.CrossRefGoogle Scholar
  28. 28.
    Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129:1432–40.CrossRefGoogle Scholar
  29. 29.
    Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003;26:510–3.CrossRefGoogle Scholar
  30. 30.
    Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54.CrossRefGoogle Scholar
  31. 31.
    Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: factors that influence disparities in sepsis. Crit Care Med. 2006;34:2576–82.CrossRefGoogle Scholar
  32. 32.
    Blanco J, Muriel-Bombín A, Sagredo V, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care. 2008;12:R158.CrossRefGoogle Scholar
  33. 33.
    Brun-Buisson C, Meshaka P, Pinton P, Vallet B, EPISEPSIS Study Group. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004;30:580–8.CrossRefGoogle Scholar
  34. 34.
    Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323–33.CrossRefGoogle Scholar
  35. 35.
    van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010;23:249–54.CrossRefGoogle Scholar
  36. 36.
    Acosta CD, Harrison DA, Rowan K, Lucas DN, Kurinczuk JJ, Knight M. Maternal morbidity and mortality from severe sepsis: a national cohort study. BMJ Open. 2016;6:e012323.CrossRefGoogle Scholar
  37. 37.
    Mayr FB, Yende S, Linde-Zwirble WT, Peck-Palmer OM, Barnato AE, Weissfeld LA, Angus DC. Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis. JAMA. 2010;303:2495–503.CrossRefGoogle Scholar
  38. 38.
    Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Occurrence and outcomes of sepsis: influence of race. Crit Care Med. 2007;35:763–8.CrossRefGoogle Scholar
  39. 39.
    Barnato AE, Alexander SL, Linde-Zwirble WT, Angus DC. Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics. Am J Respir Crit Care Med. 2008;177:279–84.CrossRefGoogle Scholar
  40. 40.
    O’Brien JM, Lu B, Ali NA, Levine DA, Aberegg SK, Lemeshow S. Insurance type and sepsis-associated hospitalizations and sepsis-associated mortality among US adults: a retrospective cohort study. Crit Care Lond Engl. 2011;15:R130.CrossRefGoogle Scholar
  41. 41.
    Page DB, Donnelly JP, Wang HE. Community-, healthcare-, and hospital-acquired severe sepsis hospitalizations in the University HealthSystem Consortium. Crit Care Med. 2015;43:1945–51.CrossRefGoogle Scholar
  42. 42.
    Vincent J-L, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323–9.CrossRefGoogle Scholar
  43. 43.
    Leligdowicz A, Dodek PM, Norena M, Wong H, Kumar A, Kumar A. Association between source of infection and hospital mortality in patients who have septic shock. Am J Respir Crit Care Med. 2014;189:1204–13.CrossRefGoogle Scholar
  44. 44.
    Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med. 2004;30:589–96.CrossRefGoogle Scholar
  45. 45.
    Clark E, Kumar A, Langote A, et al. Septic shock in chronic dialysis patients: clinical characteristics, antimicrobial therapy and mortality. Intensive Care Med. 2016;42:222–32.CrossRefGoogle Scholar
  46. 46.
    Almirall J, Bolíbar I, Serra-Prat M, et al. Inhaled drugs as risk factors for community-acquired pneumonia. Eur Respir J. 2010;36:1080–7.CrossRefGoogle Scholar
  47. 47.
    Sethi S. Infection as a comorbidity of COPD. Eur Respir J. 2010;35:1209–15.CrossRefGoogle Scholar
  48. 48.
    Schrag SJ, Farley MM, Petit S, Reingold A, Weston EJ, Pondo T, Hudson Jain J, Lynfield R. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics. 2016;138(6):e20162013.  https://doi.org/10.1542/peds.2016-2013.CrossRefPubMedGoogle Scholar
  49. 49.
    Cohen J, Cristofaro P, Carlet J, Opal S. New method of classifying infections in critically ill patients. Crit Care Med. 2004;32:1510–26.CrossRefGoogle Scholar
  50. 50.
    Sadikot RT, Blackwell TS, Christman JW, Prince AS. Pathogen–host interactions in Pseudomonas aeruginosa pneumonia. Am J Respir Crit Care Med. 2005;171:1209–23.CrossRefGoogle Scholar
  51. 51.
    Prescott HC, Langa KM, Liu V, Escobar GJ, Iwashyna TJ. Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med. 2014;190:62–9.CrossRefGoogle Scholar
  52. 52.
    Shankar-Hari M, Harrison DA, Rowan KM. Differences in impact of definitional elements on mortality precludes international comparisons of sepsis epidemiology-a cohort study illustrating the need for standardized reporting. Crit Care Med. 2016;44:2223–30.CrossRefGoogle Scholar
  53. 53.
    Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ. Late mortality after sepsis: propensity matched cohort study. BMJ. 2016;353:i2375.CrossRefGoogle Scholar
  54. 54.
    Quartin AA, Schein RM, Kett DH, Peduzzi PN. Magnitude and duration of the effect of sepsis on survival. Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group. JAMA. 1997;277:1058–63.CrossRefGoogle Scholar
  55. 55.
    Ou S-M, Chu H, Chao P-W, Lee Y-J, Kuo S-C, Chen T-J, Tseng C-M, Shih C-J, Chen Y-T. Long-term mortality and major adverse cardiovascular events in sepsis survivors. A Nationwide population-based study. Am J Respir Crit Care Med. 2016;194:209–17.CrossRefGoogle Scholar
  56. 56.
    Czaja AS, Zimmerman JJ, Nathens AB. Readmission and late mortality after pediatric severe sepsis. Pediatrics. 2009;123:849–57.CrossRefGoogle Scholar
  57. 57.
    Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787–94.CrossRefGoogle Scholar
  58. 58.
    Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306–16.CrossRefGoogle Scholar
  59. 59.
    Shah FA, Pike F, Alvarez K, et al. Bidirectional relationship between cognitive function and pneumonia. Am J Respir Crit Care Med. 2013;188:586–92.CrossRefGoogle Scholar
  60. 60.
    Nikayin S, Rabiee A, Hashem MD, Huang M, Bienvenu OJ, Turnbull AE, Needham DM. Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2016;43:23–9.CrossRefGoogle Scholar
  61. 61.
    Rabiee A, Nikayin S, Hashem MD, Huang M, Dinglas VD, Bienvenu OJ, Turnbull AE, Needham DM. Depressive symptoms after critical illness: a systematic review and meta-analysis. Crit Care Med. 2016;44:1744–53.CrossRefGoogle Scholar
  62. 62.
    Parker AM, Sricharoenchai T, Raparla S, Schneck KW, Bienvenu OJ, Needham DM. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med. 2015;43:1121–9.CrossRefGoogle Scholar
  63. 63.
    Davydow DS, Hough CL, Langa KM, Iwashyna TJ. Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. Am J Geriatr Psychiatry. 2013;21:887–97.CrossRefGoogle Scholar
  64. 64.
    Huang C, Daniels R, Lembo A, Heymann T, O’Brien J, Hartog C, Reinhart K, Nguyen HB. Mental, physiologic, and functional disabilities in post-sepsis syndrome: an international survey. Crit Care Med. 2016;44:429.Google Scholar
  65. 65.
    Prescott HC, Langa KM, Iwashyna TJ. Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. JAMA. 2015;313:1055–7.CrossRefGoogle Scholar
  66. 66.
    Shen H-N, Lu C-L, Yang H-H. Risk of recurrence after surviving severe sepsis. Crit Care Med. 2016;44:1833–41.CrossRefGoogle Scholar
  67. 67.
    DeMerle K, Royer S, Mikkelsen M, Prescott H. Readmissions for recurrent sepsis: new or relapsed infection? Crit Care Med. 2017;45(10):1702–8.CrossRefGoogle Scholar
  68. 68.
    Prescott HC. Toward a nuanced understanding of the role of infection in readmissions after sepsis. Crit Care Med. 2016;44:634–5.CrossRefGoogle Scholar
  69. 69.
    Yende S, Linde-Zwirble W, Mayr F, Weissfeld LA, Reis S, Angus DC. Risk of cardiovascular events in survivors of severe sepsis. Am J Respir Crit Care Med. 2014;189:1065–74.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  2. 2.VA Center for Clinical Management Research, HSR&D Center of InnovationAnn ArborUSA

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