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Epidemiology of severe sepsis and septic shock in Germany: results from the German 'Prevalence' study

Although a large number of epidemiological sepsis studies have been performed in Europe and the United States in the past years, sound data for Germany are so far lacking. In the 'Prevalence of Severe Sepsis and Septic Shock in Intensive Care Units in Germany' study, a prospective observational cross-sectional study, the network gathered data from 454 randomly selected ICUs in 310 hospitals in Germany and screened 3877 patients – according to the ACCP/SCCM Consensus Conference criteria – by local 1-day visits of trained physicians from the 17 German Competence Network Sepsis (SepNet) regional study centers. Visits were randomly distributed over a 1-year period (2003) to allow assessment of seasonal variations of sepsis prevalence. The ICU sample was taken from a registry of all German hospitals with ICUs (1380 hospitals with 2075 ICUs). Pediatric ICUs were not considered. The study was completed in January 2004 and the database was closed on 31 May. Seven percent of ICUs were situated in university, 34% in university-affiliated and 53% in general hospitals. Fifty-six percent of ICU directors were anesthesiologists and 26% internists. An infection was microbiologically documented in 22% and diagnosed by clinical criteria alone in 12% of screened patients. Respiratory tract infections were most common (52%), followed by intra-abdominal (15%) and urogenital infections (7%). Gram-negative and Gram-positive infections were nearly equally distributed (33% vs 35%); in 16% a fungal infection was suspected. The prevalence of sepsis was 12%, infection without SIRS was 7%, and severe sepsis/septic shock was 11%. There were significant differences in the prevalence of severe sepsis/septic shock over 1 year with the highest prevalence in May/June 2003 (18%). The infection was ICU acquired in 37%, hospital acquired in 20% and community acquired in 35.5%. ICU mortality in patients with severe sepsis/septic shock was 47% and hospital mortality was 54%. Based on these findings the incidence of severe sepsis/septic shock in German ICUs can be estimated as 75,000 cases per year (110 per 100,000 inhabitants), comparable with the incidence of acute myocardial infarction (143 per 100,000 inhabitants). With an estimated 40,000 deaths per year, severe sepsis/septic shock is the third most frequent cause of death in Germany after coronary artery disease and acute myocardial infarction.

Incidence and mortality rate of severe sepsis and septic shock in German ICUs are higher than reported in recent studies. This may be due to the representative sample size, the more standardized diagnostic criteria and a lower interobserver variability.


Supported by the German Federal Ministry of Education and Research (BMBF), Grant No: 01 KI 0106 and Lilly Deutschland GmbH.

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Brunkhorst, F., Engel, C., Reinhart, K. et al. Epidemiology of severe sepsis and septic shock in Germany: results from the German 'Prevalence' study. Crit Care 9, P196 (2005).

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  • Septic Shock
  • Acute Myocardial Infarction
  • Severe Sepsis
  • Standardize Diagnostic Criterion
  • Urogenital Infection