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October 11, 1993

The Sepsis Syndrome in a Dutch University Hospital: Clinical Observations

Author Affiliations

From the Department of Internal Medicine (Drs Kieft and Struyvenberg), Section of Clinical Immunology and Infectious Diseases (Dr Hoepelman), and the Department of Clinical Microbiology and Eijkman-Winkler Laboratorium for Medical Microbiology (Drs Hoepelman, Zhou, Rozenberg-Arska, and Verhoef), University Hospital Utrecht (the Netherlands).

Arch Intern Med. 1993;153(19):2241-2247. doi:10.1001/archinte.1993.00410190081010

Background:  Most studies of the cause of sepsis syndrome focus on patients hospitalized in intensive care units. In this study, we analyzed the incidence, cause, and outcome of the sepsis syndrome in all hospitalized patients.

Methods:  Clinical and microbiologic data were obtained for 382 patients (5.6% of all patients admitted) from whom blood was drawn for culture.

Results:  The incidence of the sepsis syndrome was 13.6 per 1000 patients admitted (1.06 per 1000 hospital days), while the incidence of septic shock was 4.6 per 1000. The respiratory tract was the predominant infection site. Of all patients with sepsis syndrome, 38% (n=35) had positive blood cultures. More than half of these cultures (13 [57%]) were caused by gram-positive microorganisms (excluding patients receiving selective decontamination of the digestive tract and those with intravascular device-related bacteremias). The mortality for patients with sepsis syndrome without shock was 28% (17/61), while for patients with septic shock, it was 55% (17/31). Patients with cardiovascular diseases had a significantly (P<.005) greater risk of dying during a sepsis syndrome episode than patients with other predisposing factors. Multivariate analysis of factors influencing outcome identified the development of shock and an immunocompromised state as being significantly associated with outcome in patients with sepsis syndrome.

Conclusions:  Patients fulfilling the criteria for the sepsis syndrome are at great risk of developing septic shock or multiple-organ failure and subsequently dying. In our hospital, the majority of bacteremic episodes were associated with gram-positive microorganisms.(Arch Intern Med. 1993;153:2241-2247)