Variations in Organism-Specific Severe Sepsis Mortality in the United States: 1999-2008
Variations in Organism-Specific Severe Sepsis Mortality in the United States: 1999-2008
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DOI：
10.1097/ccm.0000000000000555
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发表时间：
2015-01-01
影响因子：
8.8
通讯作者：
Nguyen, H. Bryant
中科院分区：
文献类型：
--
作者：
Ani, Chizobam;Farshidpanah, Siavash;Nguyen, H. Bryant
目的：最近的研究报告了总体严重脓毒症死亡率下降，但与生物体趋势的相关性尚未研究。本研究探讨了1999年至2008年基于医院的大型管理数据库中生物体特异性严重脓毒症死亡率的趋势。设计：使用全国住院患者样本进行二级数据分析。设置：在全国住院患者样本数据集中抽样的美国医院。患者：该样本近似于美国所有为成人服务的非联邦、短期、综合和专科医院的20%分层样本。严重脓毒症住院治疗和有机体特异性的原因，确定使用预定的国际疾病分类，第9次修订，临床修改codes.Interventions：无测量和主要结果：分析进行了描述性考克斯比例风险和线性回归趋势分析。对人口统计学、合并症、微生物数量和器官衰竭数量对住院死亡率的影响进行了调整。对5，033，257例严重脓毒症住院患者的数据进行了检查，发现在研究期间，住院死亡率从40.0%降至27.8%。导致严重脓毒症的主要原因是51.5%的革兰氏阴性菌，其次是45.6%的革兰氏阳性菌，1.7%的厌氧菌和1.2%的真菌。最常见的革兰阴性菌是大肠埃希菌和假单胞菌，分别占39.9%和17.6%。葡萄球菌属（62.2%的甲氧西林敏感金黄色葡萄球菌和22.6%的链球菌）是最常见的革兰氏阳性菌。厌氧和真菌生物的粗死亡率估计值较高，分别为34.5%和31.4%。在革兰氏阳性菌中，对甲氧西林敏感的S.金黄色葡萄球菌，30.9%，而假单胞菌与革兰氏阴性败血症病例的最高死亡率相关，29.5%。调整协变量后，厌氧菌与最高死亡风险1.31（95%CI，1.23-1.40）相关。耐甲氧西林表皮葡萄金黄色葡萄球菌有最高的死亡率的危险为1.38（1.33-1.44）的革兰氏阳性organisms，而所有革兰氏阴性细菌有降低的死亡率hazards.Conclusions：我们不仅证实了从1999年到2008年严重脓毒症死亡率的总体下降，但也确定了以前未报告的变化，在生物体特异性严重脓毒症死亡率。革兰氏阴性菌占优势，而厌氧菌和耐甲氧西林的S。金黄色葡萄球菌是死亡率的重要预测因子。未来探索严重脓毒症新治疗方法的临床试验应纳入个体生物趋势，以阐明对死亡率的潜在影响。
Objective: Recent studies have reported decreased overall severe sepsis mortality, but associations with organism trends have not yet been investigated. This study explored organism-specific severe sepsis mortality trends from 1999 to 2008 in a large hospital-based administrative database.Design: Secondary data analysis using the Nationwide Inpatient Sample.Setting: United States hospitals sampled in the Nationwide Inpatient Sample dataset.Patients: This sample approximates a stratified 20% sample of all nonfederal, short-term, general, and specialty hospitals serving adults in the United States. Severe sepsis hospitalizations and organism-specific causes were identified using predetermined International Classification of Diseases, 9th Revision, Clinical Modification codes.Interventions: None.Measurements and Main Results: Analysis was conducted using descriptive Cox proportional hazards and linear regression trend analysis. Adjustments were made for the influence of demographics, comorbidities, number of organisms, and number of organ failures on hospital mortality. The data for 5,033,257 severe sepsis hospitalizations were examined and revealed decreased in-hospital mortality from 40.0% to 27.8% during the study period. The leading cause of severe sepsis was 51.5% Gram-negative bacteria, followed by 45.6% Gram-positive, 1.7% anaerobic, and 1.2% fungal species. The most common Gram-negative organisms were 39.9% Escherichia coli and 17.6% Pseudomonas. Staphylococcus species (62.2% methicillin-sensitive Staphylococcus aureus and 22.6% Streptococcus) were the most commonly reported Gram-positive organisms. Crude mortality estimates were higher for anaerobic and fungal organisms, 34.5% and 31.4%, respectively. Among Gram-positive bacteria, mortality was highest for methicillin-sensitive S. aureus, 30.9%, whereas Pseudomonas was associated with the highest mortality for Gram-negative septicemia cases, 29.5%. After adjusting for covariates, anaerobes were associated with the highest mortality hazard of 1.31 (95% CI, 1.23-1.40). Methicillin-resistant S. aureus had the highest mortality hazard of 1.38 (1.33-1.44) for Gram-positive organisms, whereas all Gram-negative bacteria had decreased mortality hazards.Conclusions: We not only confirmed an overall decline in severe sepsis mortality from 1999 to 2008 but also identified previously unreported variations in organism-specific severe sepsis mortality. Gram-negative organisms predominate, whereas anaerobes and methicillin-resistant S. aureus are significant predictors of mortality. Future clinical trials exploring new treatments in severe sepsis should incorporate individual organism trends to elucidate potential effect on mortality.