Epidemiology of severe sepsis in India: an update

Introduction

A multicentre, prospective, observational study conducted in four intensive therapy units (ITUs) in India from June 2006 to June 2009 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. Patient with severe sepsis were further studied.

Results

A total of 5,478 ITU admissions were studied. SIRS with organ dysfunction was found in 1,385 (25%) patients, of which 731 (52.77%) were due to sepsis. The incidence of severe sepsis was 16.45% of all admissions. Mean age of the study population was 58.17 years (SD 18.66), of which 57.71% were male. The median APACHE II score was 13 (IQR 13 to 14) with predominant (90.93%) medical admission. ITU mortality of all admissions was 12.08% and that of severe sepsis was 59.26%. Hospital mortality and 28-day mortality of severe sepsis were 65.2% and 64.6%, respectively. The standardized mortality ratio of severe sepsis patients was 1.45. Median duration of stay in the ITU for the severe sepsis cohort who survived was 13 days (IQR 11 to 17). The number of episodes where infection was the primary reason for admission to the ITU was 86.32%. Culture positivity was found in 61.6%. The lung was the predominant source of sepsis (57.45%). Gram-negative organisms were responsible for 72.45% of cases and Gram-positive for 13.13%. The rest were parasitic, viral and fungal infection.

Conclusions

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