Infectious Foci, Comorbidities and Its Influence on the Outcomes of Septic Critically Ill Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Protocol
2.2. Statistical Analysis
3. Results
3.1. Demographics and Baseline Characteristics
3.2. Community- and Hospital-Acquired Infections
3.3. Positive Blood Cultures
3.4. Clinical Outcomes
4. Discussion
4.1. Infection Foci
4.2. Community and Hospital-Acquired Infections
4.3. Bacteremia
4.4. Septic Shock
4.5. Mortality
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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Lung (N = 400) | Urinary (N = 182) | Biliary Tract Infection (N = 115) | Peritonitis (N = 270) | Other IAI (N = 88) | Endocarditis (N = 21) | SSSI (N = 108) | CNS (N = 28) | Other (N = 84) | Total (N = 1296) | |
---|---|---|---|---|---|---|---|---|---|---|
Male sex | 66.5% | 50% | 52.2% | 58.1% | 43.2% | 61.9% | 62% | 50.0% | 59.5% | 58.1% |
Age (years) * | 66.3 ± 16.3 | 70.1 ± 11.8 | 71.3 ± 14.3 | 67.8 ± 15.4 | 67.0 ± 15.5 | 68.9 ± 15.1 | 66.6 ± 15.1 | 60.5 ± 15.6 | 65.0 ± 14.6 | 67.5 ± 15.3 |
Comorbidities | ||||||||||
Dementia | 2.5% | 2.2% | 7.8% | 1.1% | 0.0% | 0.0% | 1.9% | 0.0% | 0.0% | 28 (2.2%) |
Diabetes | 29.5% | 30.2% | 28.7% | 26.3% | 23.9% | 42.9% | 40.7% | 39.3% | 25.0% | 383 (29.6%) |
Arterial Hypertension | 40.5% | 47.8% | 57.4% | 44.4% | 53.4% | 47.6% | 39.8% | 42.9% | 32.1% | 574 (44.3%) |
HF | 18.3% | 15.4% | 9.6% | 8.1% | 13.6% | 23.8% | 22.2% | 7.1% | 10.7% | 186 (14.4%) |
Obesity | 9% | 14.8% | 13.9% | 13.3% | 12.5% | 4.8% | 13.0% | 7.1% | 7.1% | 149 (11.5%) |
Cancer | 9.3% | 13.2% | 11.3% | 30% | 13.6% | 4.8% | 5.6% | 0.0% | 9.5% | 182 (14.0%) |
Hematologic cancer | 4.5% | 3.3% | 1.7% | 3.0% | 5.7% | 4.8% | 9.3% | 3.6% | 8.3% | 58 (4.5%) |
COPD | 22.5% | 13.2% | 11.3% | 9.3% | 11.4% | 14.3% | 11.1% | 3.6% | 11.1% | 189 (14.6%) |
CKD | 14.0% | 24.2% | 12.2% | 13.0% | 18.2% | 33.3% | 16.7% | 7.1% | 20.2% | 209 (16.1%) |
CHD | 4.5% | 2.2% | 7.0% | 7.8% | 3.4% | 0.0% | 4.6% | 0.0% | 4.8% | 63 (4.9%) |
Community-acquired | 73.0% | 61.0% | 35.7% | 28.9% | 55.7% | 38.1% | 51.9% | 85.7% | 64.3% | 713 (55.0%) |
Hospital | Community | p | ||
---|---|---|---|---|
Focus of Infection | Lung | 108 (27%) | 292 (73%) | <0.001 |
Urinary | 71 (39%) | 111 (61%) | ||
Biliary tract | 74 (64.3%) | 41 (35.7%) | ||
Peritonitis | 192 (71.1%) | 78 (28.9%) | ||
Other IAI | 39 (44.3%) | 49 (55.7%) | ||
Endocarditis | 13 (61.9%) | 8 (38.1%) | ||
SSSI | 52 (48.1%) | 56 (51.9%) | ||
CNS | 4 (14.3%) | 24 (85.7%) | ||
Other | 30 (35.7%) | 54 (64.3%) | ||
Bacteremia | 28.0% | 21.4% | 0.055 | |
Age | 68.6 ± 15.4 | 66.6 ± 15.1 | 0.018 * | |
SAPS II | 43.9 ± 19.2 | 44.3 ± 19.5 | 0.46 * | |
ICU LOS | 5 [3–9] | 5 [3–8] | 0.99 ** | |
Hospital LOS | 14 [7–32] | 11 [6–22.5] | <0.001 ** | |
RRT | 21.3% | 23.1% | 0.461 | |
Vasopressors | 56.3% | 51.8% | 0.117 | |
IMV | 41.7% | 30.2% | <0.001 | |
ICU Mortality | 25.9% | 22.2% | 0.117 | |
Hosp Mortality | 36.4% | 30.3% | 0.024 |
Bacteremia | Negative Blood Cultures | p | ||
---|---|---|---|---|
N | 160 | 495 | ||
RRT | 28.1% | 24.8% | 0.407 | |
IMV | 32.5% | 39.2% | 0.134 | |
Vasopressors | 61.3% | 56.4% | 0.312 | |
ICU LOS | 5 [3–9] | 5 [3–9] | 0.46 ** | |
Hospital LOS | 13 [7–24] | 11 [5–25.75] | 0.47 ** | |
ICU Mortality | 37.5% | 25.9% | 0.006 | |
Hospital Mortality | 33.9% | 45.0% | 0.014 | |
1-Year Mortality | 56.1% | 45.2% | 0.022 | |
Age | 69.4 ± 13.6 | 68.0 ± 14.2 | 0.263 * | |
SAPS II | 49.7 ± 19.9 | 45.6 ± 18.1 | 0.028 * | |
Focus of Infection | <0.001 | |||
Lung | 17 (7.6%) | |||
Urinary | 31 (34.8%) | |||
Biliary tract | 26 (44.8%) | |||
Peritonitis | 30 (27.0%) | |||
Other IAI | 12 (29.3%) | |||
Endocarditis | 6 (40.0%) | |||
SSSI | 16 (25.8%) | |||
CNS | 0 (0.0%) | |||
Other | 22 (47.8%) |
N | Hospital Mortality | ||
---|---|---|---|
Gram positive | 47 | 46.8% | |
Staphylococcus spp. | 14 | 46.7% | |
Streptococcus spp | 5 | 41.7% | |
Enterococcus spp. | 2 | 100% | |
Other Gram Positive | 1 | 33% | |
Gram Negative | 99 | 41.4% | |
Klebsiella spp | 33 | 45.5% | |
Escherichia spp. | 42 | 35.7% | |
Proteus spp. | 2 | 50% | |
Citrobacter spp. | 6 | 50% | |
Enterobacter spp. | 6 | 66.7% | |
Serratia spp. | 6 | 50% | |
Other Gram Negative | 5 | 20% | |
Non-fermenting Gram-negative | 14 | 60% | |
Pseudomonas spp. | 14 | 60% |
Gram Positive | Gram Negative | Non Fermenting Gram Negative | p | ||
---|---|---|---|---|---|
N | 47 | 99 | 14 | ||
Age | 67.9 ± 15.2 | 70.4 ± 13.4 | 68.1 ± 16.5 | 0.547 * | |
SAPS II | 46.2 ± 20.2 | 51.13 ± 19.7 | 49.9 ± 21.8 | 0.473 * | |
Focus of Infection | |||||
Lung | 70.6% | 17.6% | 11.8% | <0.001 | |
Urinary | 6.5% | 93.5% | 0.0% | ||
Biliary tract | 3.8% | 96.2% | 0.0% | ||
Peritonitis | 13.3% | 76.7% | 10% | ||
Other IAI | 33.3% | 41.7% | 25% | ||
Endocarditis | 100% | 0.0% | 0.0% | ||
SSSI | 37.5% | 31.3% | 31.3% | ||
Other | 54.5% | 36.4% | 9.1% | ||
RRT | 29.8% | 29.6% | 13.3% | 0.408 | |
IMV | 31.9% | 32.7% | 33.3% | 0.993 | |
Vasopressors | 55.3% | 61.2% | 80% | 0.232 | |
ICU LOS | 6 [3–9] | 5 [3–8] | 4 [1–9] | 0.24 ** | |
Hospital LOS | 16 [5–31] | 11.5 [5–23.2] | 8 [1–23] | 0.47 ** | |
ICU Mortality | 36.2% | 36.7% | 46.7% | 0.742 | |
Hospital Mortality | 46.8% | 41.8% | 60% | 0.402 | |
1-Year Mortality | 31.8% | 55.7% | 71.4% | 0.022 |
Hospital Mortality | Standard Mortality | One-Year Mortality | OR if Septic Shock* | 95% CI | |
---|---|---|---|---|---|
Lung | 34.5% | 0.88 | 42.8% | 6.8 | 3.9–11.8 |
Urinary | 22.5% | 0.53 | 40.1% | 4.8 | 2.2–10.7 |
Biliary | 20.9% | 0.46 | 33.9% | 2.0 | 0.8–05.1 |
Peritonitis | 40.4% | 0.90 | 53.3% | 6.4 | 3.7–11.0 |
Other IAI | 31.8% | 0.66 | 38.6% | 11.3 | 3.1–41.9 |
Endocarditis | 57.1% | 1.49 | 66.7% | 0.9 | 0.2–05.1 |
SSSI | 29.6% | 0.74 | 43.5% | 4.4 | 1.8–10.6 |
CNS | 42.9% | 0.94 | 46.4% | 1.4 | 0.2–11.7 |
Other | 38.1% | 0.92 | 47.6% | 3.8 | 1.5–09.8 |
Septic Shock | Sepsis | p | |
---|---|---|---|
RRT | 37.7% | 12.9% | <0.001 |
IMV | 52.1% | 25.1% | <0.001 |
ICU LOS | 5 [2–10] | 5 [3–8] | 0.741 ** |
Hospital LOS | 11 [3–25] | 7 [13–26] | <0.001 ** |
ICU Mortality | 42.0% | 12.8% | <0.001 |
Hospital Mortality | 51.1% | 22.0% | <0.001 |
1-Year Mortality | 60.5% | 35.0% | <0.001 |
Age | 70.2 ± 14.1 | 65.9 ± 21.3 | <0.001 * |
SAPS II | 51.8 ± 16.6 | 39.5 ± 16.6 | <0.001 * |
Bacteremia | 35.6% | 16.6% | <0.001 |
Community-acquired infection | 34.1% | 65.9% | 0.002 |
Hospital-acquired infection | 42.5% | 57.5% |
OR | 95% CI | p | |
---|---|---|---|
SAPS II | 1.03 | 1.02–1.04 | p < 0.001 |
Age | 1.03 | 1.02–1.04 | p < 0.001 |
Chronic hypertension | 0.56 | 0.42–0.73 | p < 0.001 |
Solid neoplasia | 1.76 | 1.20–2.56 | p = 0.004 |
Hematological neoplasia | 1.83 | 1.00–3.33 | p = 0.049 |
Chronic kidney disease | 1.63 | 1.15–2.30 | p = 0.006 |
Chronic hepatic disease | 2.63 | 1.50–4.62 | p < 0.001 |
Community-acquired infection | 0.72 | 0.54–0.97 | p = 0.029 |
Infection focus * | p < 0.001 | ||
Lung | 0.93 | 0.54–1.60 | p = 0.792 |
Urinary tract | 0.41 | 0.22–0.76 | p = 0.005 |
Biliary tract | 0.33 | 0.16–0.67 | p = 0.002 |
Peritonitis | 0.80 | 0.45–1.43 | p = 0.450 |
Other Intra-abdominal | 0.63 | 0.31–1.31 | p = 0.217 |
Endocarditis | 2.64 | 0.90–7.72 | p = 0.076 |
Skin and Skin structures | 0.64 | 0.33–1.26 | p = 0.201 |
Central nervous system | 1.60 | 0.59–4.35 | p = 0.359 |
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Oliveira, A.M.; Oliveira, A.; Vidal, R.; Gonçalves-Pereira, J. Infectious Foci, Comorbidities and Its Influence on the Outcomes of Septic Critically Ill Patients. Microorganisms 2024, 12, 1705. https://doi.org/10.3390/microorganisms12081705
Oliveira AM, Oliveira A, Vidal R, Gonçalves-Pereira J. Infectious Foci, Comorbidities and Its Influence on the Outcomes of Septic Critically Ill Patients. Microorganisms. 2024; 12(8):1705. https://doi.org/10.3390/microorganisms12081705
Chicago/Turabian StyleOliveira, Ana Maria, André Oliveira, Raquel Vidal, and João Gonçalves-Pereira. 2024. "Infectious Foci, Comorbidities and Its Influence on the Outcomes of Septic Critically Ill Patients" Microorganisms 12, no. 8: 1705. https://doi.org/10.3390/microorganisms12081705