Dead Case of Community Acquired Sepsis in Medicine Department of Nakornping Hospital and Changing of Health Care System

Abstract

           In 2006, Sepsis syndrome was the first leading cause of death and very high resource using disease in medicine department of Nakornping hospital. This study was mentioned about epidemiology of sepsis syndrome. Objective: To study the characteristics and clinical manifestations of community acquired sepsis patients who were death in medicine department of Nakornping hospital during 1st October 2005 to 30th September 2006. Method: This research was descriptive study that to collect general information, risk factors, clinical manifestations, complications, antibiotics use, investigations and average cost per case. This data was collected form medical records of dead patients who were admitted with diagnosis of sepsis or septicemia in medicine department of Nakornpin hospital from ist October 2005 to 30th September 2006 by retrospectively reviewing. Result: There were 167 patients, who met sepsis criteria, 121 patients were male and 46 patients were female. The mean age was 56±17.9 years. The mostly of patients were referred from other hospitals (67.2%). The length of stay in the hospital was 3.33±3 days by average. The three most common underling diseases were diabetes mellitus, cirrhosis and chronic renal failure in orderly. Common clinical presentations were fever with chill, tachycardia (heart rate>100/min) and tachypnea (respiratory rate>20/min). The most common abnormal investigations were azotemia, followed by anemia and abnormal liver function test. Respiratory tract infection was the most common site of infection (28.95%), the second one was gastrointestinal tract infection (14.4%). 35.96% of the patients were unknown source in infection. Septic shock (77.2%), acute renal failure (64.9%) and respiratory failure (63.15%) were three most complications. Almost of the patients died due to multi-organ failure, Blood cultures were positive in only 18.01%. The frequent use antibiotics were ceftriaxone (25.44%) and combination regimens more than one drug (60.38%). Mean cost was 37,901 baht and showed tendency to increase in the future, Conclusion: Overall, most of the patients were elderly and male, Most of them were referred from other hospital. Diabetes mellitus, cirrhosis and chronic renal failure were the three most common underlying diseases. Most referred patients had more then two organs failure that meant high mortality rate :70%. The positive results of blood cultures in this study were lower than other study. From this study, there is chance to improve the process of referral system, especially in the field of investigation, early and appropriate management of sepsis.