Severe sepsis and septic shock in Croatian ICUs

Introduction

Diagnosis of sepsis is one of the most frequent in ICUs. Severe sepsis and septic shock, major complications of infection with mortality rates of 20–60%, are among the gravest problems for ICU physicians. The Surviving Sepsis Campaign with its guidelines aims to reduce mortality of severe sepsis by 25%, but no data concerning the incidence and mortality of sepsis in Croatia existed until now. The purpose of our study was to determine basic epidemiological facts about sepsis in Croatia.

Methods

Twenty-four ICUs from five clinical hospitals and four general hospitals participated in the project named croicu-net. Participating units cover the population of about 1 million (roughly one-quarter of the Croatian population). All patients admitted to the participating ICUs were reported to the web database in which patients with sepsis were given special attention. Data were analyzed after the period of 1 year. National incidence was estimated based on the portion of Croatian population covered by the participating ICUs.

Results

The participating ICUs reported a total of 5293 admissions. Sepsis at admission or during the ICU stay was reported for 587 patients (11.1%), of which 180 (3.4%) met criteria for severe sepsis and 129 (2.4%) for septic shock. ICU mortality for patients with sepsis, severe sepsis and septic shock was 29.1%, 35% and 34.1%, respectively. The duration of ICU stay for septic patients was 9.4 ± 1.1 days. Most of the patients with sepsis (75%) were septic on admission. The most prevalent source of the infection was the urinary tract (30.4%) followed by the respiratory tract (21.1%). The most common failing organ system was the respiratory system (73%). The most prevalent microorganisms isolated from the blood cultures were E. coli (11.6%), P. aeruginosa (9.9%) and MRSA (9.3%), and blood cultures were negative in 24% patients. There were no differences in incidence, mortality or LOS between surgical and medical ICUs. There were significant differences in mortality and ICU stay between the ICUs in clinical hospitals (28.7%; 8.3 ± 0.9 days) compared with the ICUs in small towns (55.5%; 9.1 ± 1.3 days) and large towns (31.8%; 8.6 ± 1.1 days), which did not match the differences in severity of disease measured by APACHE II and SOFA scores.

Conclusion

Sepsis is one of the most prevalent reasons for admission to ICUs in Croatia. The estimated annual incidence of sepsis in Croatia is 0.06% of population. Differences in mortalities and LOS could be reduced by equaling the quality of care, which could be accomplished by following the Surviving Sepsis Campaign guidelines. Planned data collection in the future will show how much improvement will be accomplished.