Comparative study of the prevalence of sepsis in patients admitted to
dermatology and internal medicine wards*

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Abstract

BACKGROUND

Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis.

OBJECTIVES

To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward.

METHODS

It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics.

RESULTS

We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001).

CONCLUSION

It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively.

Translated abstract

FUNDAMENTOS

A sepse é causa comum de morbimortalidade em pacientes internados. A sua prevalência está aumentando significativamente em diversas partes do mundo. Pacientes internados em enfermarias de dermatologia apresentam extensas áreas de perda da barreira cutânea, além de uso frequente de corticosteróides sistêmicos, condições favoráveis ao desenvolvimento de sepse.

OBJETIVOS

Avaliar a prevalência de sepse em pacientes internados em uma enfermaria de dermatologia e compará-la com a prevalência na enfermaria de clínica médica.

MÉTODOS

Trata-se de estudo observacional transversal comparativo de análise de prontuários realizado na Santa Casa de Belo Horizonte. Foram coletados os dados de todos os pacientes internados em quatro leitos da clínica médica e da dematologia no período de julho de 2008 e julho de 2009. Foram analisados em busca da ocorrência de sepse, diagnósticos dermatológicas, comorbidades, tipos de patógenos mais associados e perfil de antibióticos mais utilizados.

RESULTADOS

Foram analisados 185 prontuários e a prevalência de sepse entre os pacientes internados na enfermaria de dermatologia foi de 7,6% e na enfermaria de clínica médica 2,2% (p=0,10). Pacientes portadores de comorbidades, diabetes mellitus e neoplasias não demostraram maior ocorrência de sepse. O principal agente encontrado foi Staphylococcus aureus e os antibióticos mais utilizados foram ciprofloxacino e oxacilina. Houve significativa associação de sepse com o uso de corticosteróides sistêmicos (p<0,001).

CONCLUSÃO

Torna-se claro que devem ser realizados estudos epidemiológicos mais amplos e acurados no Brasil sobre a sepse, para que os esforços na prevenção e no tratamento dessa grave doença possam ser direcionados de forma mais racional.

Related collections

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Applied Logistic Regression

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The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study.

M Rangel-Frausto, D Pittet, M. Costigan … (1995)

Define the epidemiology of the four recently classified syndromes describing the biologic response to infection: systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock. Prospective cohort study with a follow-up of 28 days or until discharge if earlier. Three intensive care units and three general wards in a tertiary health care institution. Patients were included if they met at least two of the criteria for SIRS: fever or hypothermia, tachycardia, tachypnea, or abnormal white blood cell count. Development of any stage of the biologic response to infection: sepsis, severe sepsis, septic shock, end-organ dysfunction, and death. During the study period 3708 patients were admitted to the survey units, and 2527 (68%) met the criteria for SIRS. The incidence density rates for SIRS in the surgical, medical, and cardiovascular intensive care units were 857, 804, and 542 episodes per 1000 patient-days, respectively, and 671, 495, and 320 per 1000 patient-days for the medical, cardiothoracic, and general surgery wards, respectively. Among patients with SIRS, 649 (26%) developed sepsis, 467 (18%) developed severe sepsis, and 110 (4%) developed septic shock. The median interval from SIRS to sepsis was inversely correlated with the number of SIRS criteria (two, three, or all four) that the patients met. As the population of patients progressed from SIRS to septic shock, increasing proportions had adult respiratory distress syndrome, disseminated intravascular coagulation, acute renal failure, and shock. Positive blood cultures were found in 17% of patients with sepsis, in 25% with severe sepsis, and in 69% with septic shock. There were also stepwise increases in mortality rates in the hierarchy from SIRS, sepsis, severe sepsis, and septic shock: 7%, 16%, 20%, and 46%, respectively. Of interest, we also observed equal numbers of patients who appeared to have sepsis, severe sepsis, and septic shock but who had negative cultures. They had been prescribed empirical antibiotics for a median of 3 days. The cause of the systemic inflammatory response in these culture-negative populations is unknown, but they had similar morbidity and mortality rates as the respective culture-positive populations. This prospective epidemiologic study of SIRS and related conditions provides, to our knowledge, the first evidence of a clinical progression from SIRS to sepsis to severe sepsis and septic shock.

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Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care

Mark Williams, Lee Braun, Liesl Cooper … (2004)

Introduction Infection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels. Methods Data for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140–208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels. Results There were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77–2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94–3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of $3.4 billion per year. Conclusion Severe sepsis is a common, deadly, and costly complication in cancer patients.

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Author and article information

Journal

Journal ID (nlm-ta): An Bras Dermatol

Journal ID (iso-abbrev): An Bras Dermatol

Journal ID (publisher-id): An Bras Dermatol

Title: Anais Brasileiros de Dermatologia

Publisher: Sociedade Brasileira de Dermatologia

ISSN (Print): 0365-0596

ISSN (Electronic): 1806-4841

Publication date (Print): Sep-Oct 2013

Volume: 88

Issue: 5

Pages: 739-747

Affiliations

[1 ] Dermatopathology Fellow at the University of Colorado USA, MSc in Medicine - Professor of Dermatology, College of Medical Sciences of Minas Gerais (Faculdade de Ciências Médicas de Minas Gerais - FCMMG); Preceptor of the Residency Program of Dermatology at Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil.

[2 ] MSc in Public Health, PhD in Adult Health (in progress) - Preceptor of the Residency Program of Dermatology at Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil.

[3 ] General Practitioner - Resident of General Surgery at San José Hospital - Belo Horizonte (MG), Brazil.

[4 ] Specialist and MSc in Dermatology, Ph.D. in Medicine - Head of the Dermatology Clinic at Hospital Santa Casa de Belo Horizonte and of the Department of Dermatology, College of Medical Sciences of Minas Gerais (FCMMG), Belo Horizonte (MG), Brazil.

[5 ] PhD in Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais (UFMG) - Coordinator of the Postgraduate Program and Research of the Institute of Education and Research of Hospital Santa Casa de Belo Horizonte - Belo Horizonte (MG), Brazil.

Author notes

MAILING ADDRESS: Michelle dos Santos Diniz, Av. Francisco Sales, 1.111 - Santa Efigênia, 30150-221 - Belo Horizonte - MG, Brazil, E-mail: michellesdmi@ 123456yahoo.com.br

Article

DOI: 10.1590/abd1806-4841.20131912

PMC ID: 3798350

PubMed ID: 24173179

SO-VID: 8058c1be-2ef3-46fb-b37f-cad8fd7c2d06

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 05 June 2012

Date accepted : 12 December 2012

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