Epidemiology of severe sepsis in India

Introduction

A multicentre, prospective, observational study conducted in four intensive therapy units (ITUs) in India from June 2006 to September 2008 to determine the incidence and outcome of severe sepsis among adult patients.

Methods

All patients admitted to the ITU were screened daily for SIRS, organ dysfunction and severe sepsis as defined by the ACCP and SCCM. Patients with severe sepsis were further studied.

Results

A total of 4,183 ITU admissions were studied. SIRS with organ dysfunction was found in 1,286 (30.74%) patients, of which 688 (53.50%) were due to severe sepsis. The incidence of severe sepsis was 16.45% of all admissions. The mean age of the study population was 56.72 years (SD = 18.20), of which 62.63% were male. The median APACHE II score was 19 (IQR 18 to 20) with predominant (90.93%) medical admission. The ITU mortality of all admissions was 17.70% and that of severe sepsis was 46.30%. The hospital mortality and 28-day mortality of severe sepsis were 53.39% and 55.05%, respectively. The standardized mortality ratio of severe sepsis patients was 2.20. The median duration of stay in the ITU for the severe sepsis cohort who survived was 4 days (IQR 4 to 5). The number of episodes where infection was the primary reason for admission to the ITU was 98.11%. Culture positivity was found in 44.48%. Lung was the predominant source of sepsis (35.90%). Gram-negative organisms were responsible for 57.86% of cases and Gram-positive for 16.63%. The rest were parasitic, viral and fungal infections.

Conclusion

Severe sepsis was common in Indian ITUs. The ITU mortality was higher compared with the western literature. Gram-positive infections were less common although the incidence of parasitic and viral infection was higher than in the West.