Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study

Autoři: Eric H. Chou aff001;  Shaynna Mann aff001;  Tzu-Chun Hsu aff003;  Wan-Ting Hsu aff004;  Carolyn Chia-Yu Liu aff005;  Toral Bhakta aff002;  Dahlia M. Hassani aff002;  Chien-Chang Lee aff003
Působiště autorů: Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, Texas, United States of America aff001;  Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center, Fort Worth, Texas, United States of America aff002;  Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan aff003;  Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America aff004;  McTimoney College of Chiropractic, School of Health, BPP University, Abingdon, Oxfordshire, United Kingdom aff005
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227752



To determine the trends of infection sites and outcome of sepsis using a national population-based database.

Materials and methods

Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality.


During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%).


The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.

Klíčová slova:

Bacteremia – Bloodstream infections – Death rates – Fungal diseases – Genitourinary infections – Lower respiratory tract infections – Sepsis – Skin infections


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2020 Číslo 1