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首页> 外文期刊>JAMA: the Journal of the American Medical Association >Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group.
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Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group.

机译：8个学术医学中心的败血症综合征流行病学。学术医学中心财团败血症项目工作组。

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CONTEXT: Sepsis syndrome is a leading cause of mortality in hospitalized patients. However, few studies have described the epidemiology of sepsis syndrome in a hospitalwide population. OBJECTIVE: To describe the epidemiology of sepsis syndrome in the tertiary care hospital setting. DESIGN: Prospective, multi-institutional, observational study including 5-month follow-up. SETTING: Eight academic tertiary care centers. METHODS: Each center monitored a weighted random sample of intensive care unit (ICU) patients, non-ICU patients who had blood cultures drawn, and all patients who received a novel therapeutic agent or who died in an emergency department or ICU. Sepsis syndrome was defined as the presence of either a positive blood culture or the combination of fever, tachypnea, tachycardia, clinically suspected infection, and any 1 of 7 confirmatory criteria. Estimates of total cases expected annually were extrapolated from the number of cases, the period of observation, and the sampling fraction. RESULTS:From January 4, 1993, to April 2, 1994, 12759 patients were monitored and 1342 episodes of sepsis syndrome were documented. The extrapolated, weighted estimate of hospitalwide incidence (mean+/-95% confidence limit) of sepsis syndrome was 2.0+/-0.16 cases per 100 admissions, or 2.8+/-0.17 per 1000 patient-days. The unadjusted attack rate for sepsis syndrome between individual centers differed by as much as 3-fold, but after adjustment for institutional differences in organ transplant populations, variation from the expected number of cases was reduced to 2-fold and was not statistically significant overall. Patients in ICUs accounted for 59% of total extrapolated cases, non-ICU patients with positive blood cultures for 11%, and non-ICU patients with negative blood cultures for 30%. Septic shock was present at onset of sepsis syndrome in 25% of patients. Bloodstream infection was documented in 28%, with gram-positive organisms being the most frequent isolates. Mortality was 34% at 28 days and 45% at 5 months. CONCLUSIONS: Sepsis syndrome is common in academic hospitals, although the overall rates vary considerably with the patient population. A substantial fraction of cases occur outside ICUs. An understanding of the hospitalwide epidemiology of sepsis syndrome is vital for rational planning and treatment of hospitalized patients with sepsis syndrome, especially as new and expensive therapeutic agents become available.
机译：背景：脓毒症综合征是住院患者死亡的主要原因。然而，很少有研究描述全院人群败血症综合征的流行病学。目的：描述三级医院败血症综合征的流行病学。设计：前瞻性，多机构，观察性研究，包括5个月的随访。地点：八个学术三级护理中心。方法：每个中心均对重症监护病房（ICU）患者，抽血培养的非ICU患者以及所有接受新型治疗药物或在急诊室或ICU中死亡的患者进行加权随机抽样监测。脓毒症综合征的定义为存在阳性血液培养或出现发烧，呼吸急促，心动过速，临床怀疑感染和7种确认标准中的任何一种。从病例数，观察期和抽样比例推断出每年预期的总病例数。结果：从1993年1月4日至1994年4月2日，监测了12759例患者，并记录了1342例脓毒症综合征。脓毒症综合征全院发病率（均值+/- 95％置信限）的推断加权估计为每100例入院2.0 +/- 0.16例，或每1000个病人日2.8 +/- 0.17例。各个中心之间败血症综合征未经调整的发作率相差多达3倍，但在对器官移植人群的机构差异进行调整后，预期病例数的差异减少至2倍，总体上无统计学意义。 ICU的患者占推断总数的59％，血液培养阳性的非ICU患者占11％，血液培养阴性的非ICU患者占30％。 25％的败血症综合征发作时出现败血症性休克。据记录，有28％的人感染了血流，其中革兰氏阳性菌是最常见的分离株。死亡率在28天时为34％，在5个月时为45％。结论：败血症综合征在学术医院很常见，尽管总发生率随患者人群而有很大差异。很大一部分病例发生在ICU之外。了解败血症综合症在医院范围内的流行病学对于合理规划和治疗住院的败血症综合症患者至关重要，尤其是随着新的和昂贵治疗剂的出现。

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