Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case-control study.

Autor: Zampieri FG; HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil. fzampieri@hcor.com.br.; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, AB, T6G2B7, Canada. fzampieri@hcor.com.br., Cavalcanti AB; HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil., Taniguchi LU; Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.; Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil., Lisboa TC; HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil.; Unidade de Terapia Intensiva, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil., Serpa-Neto A; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Intensive Care, Austin Hospital, Melbourne, Australia., Azevedo LCP; Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.; Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil., Nassar AP Jr; Intensive Care Unit, AC Camargo Cancer Center, São Paulo, SP, Brazil., Miranda TA; HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil., Gomes SPC; HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil., de Alencar Filho MS; Hospital Maternidade São Vicente de Paulo, Barbalha, CE, Brazil., da Silva RTA; Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil., Lacerda FH; Hospital da Luz, São Paulo, SP, Brazil., Veiga VC; BP-A Beneficência Portuguesa de São Paulo, Sao Paulo, SP, Brazil., de Oliveira Manoel AL; Hospital Paulistano, São Paulo, SP, Brazil., Biondi RS; Instituto de Cardiologia do Distrito Federal, Brasilia, DF, Brazil., Maia IS; HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil.; Hospital Nereu Ramos, Florianópolis, SC, Brazil.; Hospital Baía Sul, Florianópolis, SC, Brazil., Lovato WJ; Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil., de Oliveira CD; Santa Casa de Misericórdia Belo Horizonte, Belo Horizonte, MG, Brazil., Pizzol FD; Hospital São José, Criciúma, SC, Brazil., Filho MC; Hospital Dona Helena, Joinville, SC, Brazil., Amendola CP; Hospital de Amor-Fundação PIO XII, Barretos, SP, Brazil., Westphal GA; Centro Hospitalar Unimed, Joinville, SC, Brazil., Figueiredo RC; Hospital Maternidade São José, Colatina, ES, Brazil., Caser EB; Hospital Unimed Vitória, Vitória, ES, Brazil., de Figueiredo LM; Hospital Distrital Evandro Ayres de Moura Antônio Bezerra, Fortaleza, CE, Brazil., de Freitas FGR; Hospital e Maternidade Sepaco, Sao Paulo, SP, Brazil.; Department of Anesthesiology, Pain and Critical Care-Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil., Fernandes SS; Hospital Japones Santa Cruz, Sao Paulo, SP, Brazil., Gobatto ALN; Hospital da Cidade, Salvador, BA, Brazil., Paranhos JLR; Santa Casa de Misericórdia de São João Del Rei, Belo Horizonte, MG, Brazil., de Melo RMV; Hospital Ana Nery, Salvador, BA, Brazil., Sousa MT; Fundação São Francisco de Assis, Belo Horizonte, MG, Brazil., de Almeida GMB; Hospital Regional Dr. Clodolfo Rodrigues de Melo, Maceio, AL, Brazil., Ferronatto BR; Hospital Erasto Gaertner, Curitiba, PR, Brazil., Ferreira DM; Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO, Brazil., Ramos FJS; BP-A Beneficência Portuguesa de São Paulo, Sao Paulo, SP, Brazil., Thompson MM; Hospital Evangélico de Cachoeiro de Itapemirim, Cachoeiro de Itapemirim, ES, Brazil., Grion CMC; Hospital Universitário Regional do Norte do Paraná, Londrina, PR, Brazil., Santos RHN; HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil., Damiani LP; HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil., Machado FR; Department of Anesthesiology, Pain and Critical Care-Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2023 Apr 26; Vol. 13 (1), pp. 32. Date of Electronic Publication: 2023 Apr 26.
DOI: 10.1186/s13613-023-01123-y
Abstrakt: Background: Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis.
Methods: Matched 1:1 case-control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence.
Results: 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068-0.084) for medical admissions; 0.043 (95% CI 0.032-0.055) for elective surgical admissions; and 0.036 (95% CI 0.017-0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates.
Conclusion: The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.
(© 2023. The Author(s).)
Databáze: MEDLINE
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