Severe sepsis and septic shock: recent trends in the intensive care unit of a university hospital

Abstract number: 1134_04_25

Que Y.A., Oddo M., Schaller M.D., Calandra T., Liaudet L.

Objectives:  

Severe sepsis and septic shock are associated with mortality in the range of 20–35% and 40–80%, respectively. Yet, a recent US survey among patients with sepsis has suggested that mortality may be declining and etiology is changing (NEJM 2003;348:1546). The aim of this 3-yr study was to review the etiology and outcome of patients with severe sepsis and septic shock admitted to the MICU of a university hospital in Western Switzerland.

Methods:  

Retrospective analyses of demographic, clinical, microbiological and laboratory data and therapeutic interventions of all consecutive patients admitted for severe sepsis and septic shock in the MICU. Patients referred from other hospitals were excluded.

Results:  

From Jan 2001 to Dec 2003, 218 patients developed severe sepsis (n = 78, 35.7%) or septic shock (n = 140, 64.3%)(mean: 6 cases/month). Mean age was 60 ± 16 yr., M/F ratio was 62/38%, median APACHE II score was 22.5 ± 9.5. Sepsis was due to Gram-positive bacteria in 41.6% of cases, Gram-negative bacteria in 25.4%, fungi in 4.4%, malaria in 0.9% and was culture-negative in 27.7%. All-cause day 28 mortality was 25.6% (severe sepsis: 5.5%, septic shock 37.1%). While APACHE II score increased from 24.1 to 26.3, mortality of septic shock decreased from 43% (2001) to 31% (2003), possibly in relation with the introduction of new strategies (early goal-directed therapy and lung protective ventilation, only 2 patients were treated with activated protein C) during the study period.

Conclusion:  

Gram-positive are a leading cause of severe sepsis and septic shock in the MICU of a Swiss university hospital. All-cause day 28 was much lower than anticipated and decreased during the study period confirming some recent trends.