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Meta-Analysis
. 2020 Aug;46(8):1536-1551.
doi: 10.1007/s00134-020-06106-2. Epub 2020 Jun 26.

Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis

Robby Markwart  1 , Hiroki Saito  2   3 , Thomas Harder  1 , Sara Tomczyk  1 , Alessandro Cassini  2 , Carolin Fleischmann-Struzek  4 , Felix Reichert  1   5   6 , Tim Eckmanns  1 , Benedetta Allegranzi  7
Affiliations
Meta-Analysis

Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis

Robby Markwart et al. Intensive Care Med. 2020 Aug.

Abstract

Purpose: Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospital-acquired (HA) and ICU-acquired (ICU-A) sepsis.

Methods: We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed.

Results: Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low- and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies.

Conclusion: HA sepsis is of major public health importance, and the burden is particularly high in ICUs. There is an urgent need to improve the implementation of global and local infection prevention and management strategies to reduce its high burden among hospitalized patients.

Keywords: Healthcare-acquired infections; Hospital-acquired sepsis; ICU-acquired sepsis; Incidence; Sepsis.

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Conflict of interest statement

CFS received grants from the German Federal Ministry of Education and Research (BMBF) via the Center for Sepsis Control and Care (CSCC; FKZ: 01EO1002 and 01EO1502) and from the Innovation Funds of the German government (FKZ 01VSF17010). The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study selection
Fig. 2
Fig. 2
Location and type of studies reporting hospital-acquired sepsis
Fig. 3
Fig. 3
Pooled incidence of hospital-acquired sepsis per 1000 patients in different settings. a Pooled incidence of hospital-acquired sepsis, sepsis with organ dysfunction and septic shock among patients admitted to any ward in the hospital. b Pooled incidence of ICU-acquired and hospital-acquired sepsis, sepsis with organ dysfunction and septic shock among patients admitted to the ICU. The “sepsis” group comprises studies on patients with sepsis, sepsis with organ dysfunction and septic shock. The “sepsis with organ dysfunction” group comprises studies on patients with sepsis with organ dysfunction and septic shock. HA hospital-acquired, ICU-A ICU-acquired, 95% CI 95% confidence interval
Fig. 4
Fig. 4
Pooled proportions of hospital-acquired sepsis cases among all sepsis cases. a Pooled proportions of hospital-acquired sepsis, sepsis with organ dysfunction or septic shock among hospital patients (including ICU wards) with sepsis, sepsis with organ dysfunction or septic shock. b Pooled proportions of ICU-acquired and hospital-acquired sepsis, sepsis with organ dysfunction and septic shock among ICU patients with sepsis, sepsis with organ dysfunction or septic shock. The “sepsis” group comprises studies among patients with sepsis, sepsis with organ dysfunction and septic shock. The “sepsis with organ dysfunction” group comprises studies among patients with sepsis with organ dysfunction and septic shock. HA hospital-acquired, ICU-A = ICU-acquired; 95% CI = 95% confidence interval
Fig. 5
Fig. 5
Pooled estimates of hospital-acquired neonatal sepsis on NICUs. a Pooled incidence of hospital-acquired neonatal sepsis among neonates admitted to NICUs. b Pooled proportions of hospital-acquired neonatal sepsis among NICU patients with sepsis. HA hospital-acquired
See this image and copyright information in PMC

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