Sepsis syndrome in Croatian intensive care units: piloting a national comparative clinical database

Abstract

Aim: To assess the incidence of sepsis in selected intensive care units (ICUs) in Croatia, isolates from blood cultures, and sepsis outcomes, and to compare the results with those from other European countries.

Methods: In the pilot phase of the national comparative clinical database project, we included 24 ICUs--general, specialized, neonatal, pediatric, and adult--18 from university hospitals, 3 from county hospitals, and 4 from city hospitals. By retrospective chart review, trained data collectors abstracted the data on the case mix, management strategies, and outcomes in patients consecutively admitted to ICUs. Central validation for incomplete, illogical, or inconsistent values is regularly performed to improve accurateness.

Results: Of 5293 patients treated in 24 ICUs from November 1, 2004, to October 31, 2005, 456 (8.6%) were treated for sepsis syndrome or severe sepsis. The most common isolates from positive blood cultures were Esherichia coli (11.6%), Pseudomonas species (9.9%), and methicillin-resistant Staphylococcus aureus (9.3%). With the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score of 10.0 and Sequential Organ Failure Assessment (SOFA) score of 2.4, the overall mortality for sepsis syndrome, severe sepsis, and septic shock was 29%, 35%, and 34%, respectively. When compared to university hospitals and county hospitals, city hospitals with the smallest gravitating population had significantly lower APACHE II and SOFA scores, but significantly higher mortality.

Conclusions: Overall mortality of patients with sepsis syndrome in Croatian ICUs was high, but outcomes of their treatment were comparable with those in other European countries. Better education in triage and treatment strategies is needed, including better implementation of Surviving Sepsis Campaign guidelines.