Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec 5;14(12):e0225700.
doi: 10.1371/journal.pone.0225700. eCollection 2019.

Incidences of community onset severe sepsis, Sepsis-3 sepsis, and bacteremia in Sweden - A prospective population-based study

Lars Ljungström  1   2 , Rune Andersson  1   3 , Gunnar Jacobsson  1   2   3
Affiliations

Incidences of community onset severe sepsis, Sepsis-3 sepsis, and bacteremia in Sweden - A prospective population-based study

Lars Ljungström et al. PLoS One. .

Abstract

Background: Sepsis is a major healthcare challenge globally. However, epidemiologic data based on population studies are scarce.

Methods: During a 9-month prospective, population-based study, the Swedish Sepsis-2 criteria were used to investigate the incidence of community onset severe sepsis in adults aged ≥18 years (N = 2,196; mean age, 69; range, 18-102 years). All the patients who were admitted to the hospital and started on intravenous antibiotic treatment within 48 hours were evaluated. Retrospectively the incidence of sepsis according to Sepsis-3 criteria was calculated on this cohort.

Results: The annual incidence of community onset severe sepsis in adults at first admission was 276/100,000 (95% CI, 254-300). The incidence increased more than 40-fold between the youngest and the oldest age group, and was higher for men than for women. The respiratory tract was the most common site of infection (41% of cases). Using the Sepsis-3 criteria, the annual incidence of sepsis was 838/100,000 (95% CI, 798-877), which is 3-fold higher than that of severe sepsis. The main reason for the discrepancy in incidences is the more generous criteria for respiratory dysfunction used in Sepsis-3. Bacteremia was seen in 13% of all the admitted patients, giving an incidence of 203/100,000/year (95%, CI 184-223), which is among the highest incidences reported.

Conclusions: We found a high incidence of community onset severe sepsis, albeit lower than that seen in previous Scandinavian studies. The incidence increased markedly with age of the patient. The incidence of community onset sepsis according to the Sepsis-3 definition is the highest reported to date. It is 3-fold higher than that for severe sepsis, due to more generous criteria for respiratory dysfunction. A very high incidence of bacteremia was noted, partly explained by the high frequency of blood cultures.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Patient selection flowchart for the present study.
Fig 2
Fig 2. Distribution of severe sepsis and Sepsis-3 sepsis in a cohort of 2,196 consecutive patients with suspected community onset bacterial infection receiving intravenous antibiotic treatment.
Fig 3
Fig 3. Incidence per 100,000 persons/year according to age group and gender of patients with severe sepsis (N = 429) and Sepsis-3 sepsis (N = 1,299).
Fig 4
Fig 4. Distribution of points in the SOFA-score per organ system in 1,299 consecutive patients with Sepsis-3.
The SOFA scores are corrected for the baseline levels.
Fig 5
Fig 5. Organ dysfunction rates in 482 episodes with severe sepsis, classified according to age group.
See this image and copyright information in PMC

References

    1. Fleischmann C, Scherag A, Adhikari N, Hartog C, Tsaganos T, Schlattmann P, et al. Global burden of sepsis: a systematic review. Critical Care. 2015;19(1):P21.
    1. Mariansdatter SE, Eiset AH, Søgaard KK, Christiansen CF. Differences in reported sepsis incidence according to study design: a literature review. BMC medical research methodology. 2016;16(1):137 10.1186/s12874-016-0237-9 - DOI - PMC - PubMed
    1. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, et al. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. Jama. 2017;318(13):1241–9. 10.1001/jama.2017.13836 - DOI - PMC - PubMed
    1. Henriksen DP, Laursen CB, Jensen TG, Hallas J, Lassen AT. Incidence rate of community-acquired sepsis among hospitalized acute medical patients—a population-based survey. Critical care medicine. 2015;43(1):13–21. 10.1097/CCM.0000000000000611 - DOI - PubMed
    1. Markovic MT, Gottfredsson M, Mitic MT, Gaini S. Epidemiology of community-acquired sepsis in the Faroe Islands–a prospective observational study. Infectious Diseases. 2019;51(1):38–49. 10.1080/23744235.2018.1511056 - DOI - PubMed

Publication types