Dead Case of Community Acquired Sepsis in Sisaket Hospital 2547
Article Sidebar
Main Article Content
Abstract
Background: According to sepsis was the first leading cause of death in Sisaket hospital
in 2004. The majorities were community acquired sepsis. This study, about community acquired sepsis, therefore developed in order to provide data for use in improvement of patients care.
Objective: To explore general characteristics and clinical manifestations of community acquired sepsis patients who were death in Sisaket hospital during October 2003 to September 2004.
Materials and Methods: The medical record of patients, who admitted with diagnosis of sepsis and death in Sisaket hospital from October 2003 to September 2004, were retrospectively reviewed. This descriptive study collected general informations, risk factors, clinical manifestations, complications, antibiotics use, lab investigations and cost per case.
Result: One hundred and seventy-three patients were met criteria, 76 patients were male and 97 patients were female. The mean age was 59 years (range 2-96years). Frequent finding in April to June(34.1%). Most patients had underlying disease or risk factor to infection (76.30%). Common clinical presentations were fever with chill(77.45%)and leukocytosis (in CBC, 74.56%). The most common site of infection was the respiratory system (34.10%), followed by gastrointestinal system(31.21%). Blood cultures were positive in only 25.88%. Burkholderiapseudomallei was the most frequent finding organism(59.0%). The most severity of sepsis in first date admission, septic shock and refractory septic shock, occurred in 59.53%. Three or more organ failure occurred in 29.47%. The most frequent complications were respiratory complications (66.47%), followed by acute renal failure (64.16%).The frequent use antibiotics were Ceftriaxone(63.0%) and Ceftazidime(35.83). The most finding cause of death was shock (92.48%), followed by ARDS( 10.40%). The patients who were dead in one day of admission accounting for 59.53% of all patients. Mean cost was 16,991.45 baht(404.56 $) per case.
Conclusion: Patients who died of community acquired sepsis were mostly had advanced age, underlying diseases or risk factors to infection. The clinical presentations were severe and rapid progression of disease. In patients that blood culture positive, Burkholderiapseudomallei was the most frequent finding organism. The most frequent complication was respiratory complication. The most finding cause of dead was shock.
Keywords: Septicemia
Article Details
References
2. อมร สีลารัศมี. Sepsis Syndrome, An Update on Infectious Disease.กรุงเทพฯ: สมาคมโรคติดเชื้อแห่งประเทศไทย, 2548:หน้า 68-99.
3. ธีรพงษ์ ตัณฑวิเชียร. Septic shock. ใน: วิทยา ศรีดามา(บรรณาธิการ) Emergency Medicine. กรุงเทพฯ : ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์ จุฬาลงกรณ์มหาวิทยาลัย, 2544:หน้า 175-94.
4. Spie CD, Von Dossow V, Eggers V, et al. Altered cell-mediated immunity and increased postoperative infection rate in long-term alcoholic patients. Anesthesiology. 2004 May;100(5):1088-100. Available from : URL : https://www.ncbi.nlm.nih.gov /entrez/query. fcgi?CMD=search&DB=pubmed
5. Von Dossow V, Schilling C, Beller S, et al Altered immune parameters in chronic alcoholic patients at the onset of infection and of septic shock. Crit Care. 2004 Oct;8(5):R312-21. Epub 2004 Jul 20. Available from:URL : https://www.ncbi.nlm.nih.gov /entrez/query.fcgi?CMD=search&DB=pubmed
6. American College of Chest Physicians/ Society of Critical Care Medicine, Consensus Conference: Definitions of sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864.
7. อภิรักษ์ ปาลวัฒน์วิไชย, ดุสิต สถาพร, อดิศร วงษา. ARDS(Acute Respiratory Distress Syndrome). ใน: สุชัย เจริญรัตนกุล (บรรณาธิการ). อุรเวชช์ร่วมสมัย. กรุงเทพฯ : สมาคมอุรเวชช์ แห่งประเทศไทย; 2538. หน้า 133-52.
8. สมาคมโรคไตแห่งประเทศไทย. แนวทางการสืบค้นการปรากฏของโปรตีนในปัสสาวะ. ใน: วิทยา ศรีดามา(บรรณาธิการ). Evidence-Base Clinical Practice Guideline ทางอายุรกรรม2548. กรุงเทพฯ : ภาควิชาอายุรศาสตร์คณะแพทยศาสตร์ จุฬาลงกรณ์มหาวิทยาลัย. หน้า99-104.
9. Bradley MD, Barry MB. Cardinal manifestations of renal disease. In:Anthony SF, Eugene B, Kurt JI, et al , editors. Harrison’s principle of internal medicine. 14th ed. USA:R.R.Donnelley and Sons, Inc; 1998. p. 258-61.
10. Ispahani P, Pearson NJ, Greenwood D. An analysis of community and hospital acquired bacteremia in a large teaching hospital in the United Kingdom. Q J Med 1987;63:427-40.
11.Lertpattanasuwan N. Community Acquired Bacteremia in Sisaket Hospital a 1-Years Prospective Study. Med J SisaketSurinBuriram Hosp 2004;19(1):43-59.
12. Zahorec R, Firment J, Strakova J, et al. Epidemiology of severe sepsis in intensive care units in the Slovak Republic. :Infection. 2005 Jun ; 33(3):122-8. Available from: URL: https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed.
13. Adrie C, Alberti C, Chaix-Couturier C, et al. Epidemiology and economic evaluation of severe sepsis in France: age, severity, infection site, and place of acquisition (community, hospital or intensive care unit) as determinants of workload and cost. J Crit Care. 2005 Mar;20(l):46-58. Available from: URL: https://www.ncbi.nlm.nih.gov/ entrez/query.fcgi?CMD=search&DB=pubmed.
14. Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med 1999;340:207-14.
15. Leone M, Bourgoin A, Cambon S, et al. Empyrical antimicrobial therapy of septic shock patients: adequacy and impact on the outcome. Crit Care Med. 2003 Feb;31(2):648-50.
16. Sands KE, Bates DW, Lanken PN, et al. Epidemiology of sepsis syndrome in 8 academic medical centers. JAMA 1997;278:234.
17. Rangel-Frausto MS, Pittet D, Costigan M, et al. The natural history of the systemic inflammatory response syndrome (SIRS).A prospective study. JAMA 1995;273:117.
18. Connors AF Jr, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996;276:889-97.
19. Opal SM, Cross AS. Clinical trials for severe sepsis ะ past failure and future hopes. Infect Dis Clin North Am 1999;13:285-97.
20. Hayes MA. Timmins AC, Yau EHS, et al. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994;330:1717-22.
21. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
22. Robert WS, Wei W. Acute renal failure and sepsis. N Engl J Med 2004;351:159-69.
23. Kieft H, Hoepelman AIM, Zhou W, Rozenberg-Arska M, Struyvenberg A, Verhoef J. The sepsis syndrome in a Dutch university hospital: clinical observations. Arch Intern Med 1993;153:2241-247.
24. Bernard GR, Wheeler AP, Russell JA, et al. Effects of ibuprofen on the physiology and survival of patients with sepsis. N Engl J Med 1997;336:912-18.
25. Welte T. Sepsis management-antibiotic therapy. Dtsch Med Wochenschr. 2004 Nov 26;129(489:2609-13. Available from: URL: https:// www.ncbi.nlm.nih.gov /entrez/ query. fcgi?CMD =search&DB=pubmed.
26. Antonelli M, Mercurio G, Di Nunno S, et al. De-escalation antimicrobial chemotherapy in critically ill patients : pros and cons. J Chemother. 2001 Nov; 13 Spec No 1 (1) :218-23.
