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 18 February 2018

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News

Epidemiology of sepsis in the United States from 1979 through 2000

The incidence of sepsis and the number of sepsis-related deaths are increasing, find researchers in the latest issue of the New England Journal of Medicine.

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Sepsis is a substantial health care burden. However, there is limited information about the demography of sepsis, or the temporal changes in its incidence and outcome.

In this study, researchers from the United States investigated the epidemiology of sepsis. They examined race and sex, causative organisms, the disposition of patients, and the incidence and outcome.

The team analyzed the occurrence of sepsis from 1979 to 2000, using a nationally representative sample of nonfederal acute care hospitals in the United States.

Sepsis due to fungal organisms increased by 207%.
New England Journal of Medicine

They obtained data on new cases from hospital discharge records. These were coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification.

A review of the discharge data from approximately 750 million hospitalizations identified 10,319,418 cases of sepsis, over a 22-year period.

The researchers found that sepsis was more common in men than in women (mean annual relative risk, 1.28), and in nonwhite than white persons (mean annual relative risk, 1.90).

Between 1979 and 2000, the team identified an annualized increase in the incidence of sepsis from 164,000 cases to nearly 660,000 cases. This is an increase of 9%.

In addition, the team found that the rate of sepsis due to fungal organisms increased by 207%. Gram-positive bacteria became the predominant pathogens after 1987.

The total in-hospital mortality rate fell from 28% between 1979 and 1984 to 18% between 1995 and 2000. However, the total number of deaths continued to increase.

The research team found that mortality was highest among black men.

They determined that organ failure contributed cumulatively to mortality, with temporal improvements in survival among patients with fewer than 3 failing organs.

Overall, the average length of the hospital stay decreased, but the rate of discharge to nonacute care medical facilities increased.

Dr Greg Martin's team concluded, "The incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining".

"There are also disparities among races and between men and women in the incidence of sepsis".

"Gram-positive bacteria and fungal organisms are increasingly common causes of sepsis".

New Engl J Med 2003; 348: 1546-54
22 April 2003

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