Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study

Nur Baykara, Halis Akalın, Mustafa Kemal Arslantaş, Volkan Hancı, Çiğdem Çağlayan, Ferda Kahveci, Kubilay Demirağ, Canan Baydemir, Necmettin Ünal, Sepsis Study Group, Pınar Özdemir, Hülya Ulusoy, Dilek Memiş, Cavidan Arar, Elif Yılmaz, Melek Çelik, İsmail Cinel, Sibel Temur, Mehmet Akif Yaşar, Hamdiye Tutan Çulha, Canan Balcı, Sultan San, Asena Salbes, Elçin Özkan, Onur Palabıyık, Jale Çelik, Alper Yosunkaya, Faruk Çiçekçi, Işıl Özkoçak, İsmail Katı, Hülya Başar, Sema Turan, Süheyla Ünver, Ünase Büyükkoçak, Aynur Akın, Sinan Gürsoy, Demet Tok, Simay Serin, Seda Dursun Kıter, Hakan Doğan, Abdülkadir Oruç, Onur Balaban, Dilara Tüfek, İbrahim Kurt, Murat Bilgi, Verda Tuna, Ayşegül Özkök, Ahmet Şen, Nilay Taş, Hilal Ayoğlu, Berna Kaya Uğur, Sedat Kaya, Mustafa Kahraman, Zahide Doğanay, Gökalp Soykam, Işıl Köse, Birgül Yelken, Osman Ekinci, Gönül Ölmez Kavak, Uğur Göktaş, Türkan Togal, Nazım Doğan, Murat Gündüz, Selim Turhanoğlu, Atilla Ramazanoğlu, Füsun Eroğlu, Şaban Yalçın, Hatice Yağmurdur, Atilla Tutak, Ali Aydın Altunkan, Ufuk Kuyrukluyıldız, Gülsüm Oya Hergünsel, Kerem Erkalp, Necati Gökmen, Murat Aksun, Erkan Sayan, Onur Özlü, Yavuz Demiraran, Evren Şentürk, Işın Gençay, Hafize Öksüz, Nihan Yapıcı, Araş Pirat, Tuğhan Utku, Ender Gedik, Orhan Behret, Kadir İdin, Hayrettin Daşkaya, Filiz Banu Ethemoğlu, Ali Alagöz, Seval İzdeş, Mustafa Kemal Bayar, Nermin Kelebek Girgin, Lale Karabıyık, Uğur Koca, Nurcan Çubukçu, Fatma Ülger, Şeyda Efsun Özgünay, Perihan Ergin Özcan, Başar Erdivanlı, Şenay Göksu Tomruk, Abbas Köse, Rafi Doğan, Güldem Turan, Osman Arpaz, Aliye Esmaoğlu, Musa Salmanoğlu, Özgür Canoler, Nedim Çekmen, Canan Kandaz, Gülşen Bulut Kaya, Melis Türker, İlknur Şeker, Aysu Hayriye Tezcan, Halil İbrahim Uzunlar, Mehmet Akif Yazar, Reyhan Arslantaş, Nalan Adıgüzel, Murat Aksun, Okay Öztürk, Zakir Arslan, Özgür Özmen, Günseli Orhun, Evren Büyükfırat, Oya Çimen Budur, Mehmet Erdem Akçay, Asu Özgültekin, Ertuğrul Kılıç, Makbule Elif Yılmaz, Ömür İlban, Feyza Kargın, Murat Sayın, Feyza Kargın, Resul Altuntaş, Hakan Doğan, Osman Ekinci, Berna Çalışkan, Ayşen Erdoğan, Volkan Alparslan, Murat Tekin, Nur Baykara, Halis Akalın, Mustafa Kemal Arslantaş, Volkan Hancı, Çiğdem Çağlayan, Ferda Kahveci, Kubilay Demirağ, Canan Baydemir, Necmettin Ünal, Sepsis Study Group, Pınar Özdemir, Hülya Ulusoy, Dilek Memiş, Cavidan Arar, Elif Yılmaz, Melek Çelik, İsmail Cinel, Sibel Temur, Mehmet Akif Yaşar, Hamdiye Tutan Çulha, Canan Balcı, Sultan San, Asena Salbes, Elçin Özkan, Onur Palabıyık, Jale Çelik, Alper Yosunkaya, Faruk Çiçekçi, Işıl Özkoçak, İsmail Katı, Hülya Başar, Sema Turan, Süheyla Ünver, Ünase Büyükkoçak, Aynur Akın, Sinan Gürsoy, Demet Tok, Simay Serin, Seda Dursun Kıter, Hakan Doğan, Abdülkadir Oruç, Onur Balaban, Dilara Tüfek, İbrahim Kurt, Murat Bilgi, Verda Tuna, Ayşegül Özkök, Ahmet Şen, Nilay Taş, Hilal Ayoğlu, Berna Kaya Uğur, Sedat Kaya, Mustafa Kahraman, Zahide Doğanay, Gökalp Soykam, Işıl Köse, Birgül Yelken, Osman Ekinci, Gönül Ölmez Kavak, Uğur Göktaş, Türkan Togal, Nazım Doğan, Murat Gündüz, Selim Turhanoğlu, Atilla Ramazanoğlu, Füsun Eroğlu, Şaban Yalçın, Hatice Yağmurdur, Atilla Tutak, Ali Aydın Altunkan, Ufuk Kuyrukluyıldız, Gülsüm Oya Hergünsel, Kerem Erkalp, Necati Gökmen, Murat Aksun, Erkan Sayan, Onur Özlü, Yavuz Demiraran, Evren Şentürk, Işın Gençay, Hafize Öksüz, Nihan Yapıcı, Araş Pirat, Tuğhan Utku, Ender Gedik, Orhan Behret, Kadir İdin, Hayrettin Daşkaya, Filiz Banu Ethemoğlu, Ali Alagöz, Seval İzdeş, Mustafa Kemal Bayar, Nermin Kelebek Girgin, Lale Karabıyık, Uğur Koca, Nurcan Çubukçu, Fatma Ülger, Şeyda Efsun Özgünay, Perihan Ergin Özcan, Başar Erdivanlı, Şenay Göksu Tomruk, Abbas Köse, Rafi Doğan, Güldem Turan, Osman Arpaz, Aliye Esmaoğlu, Musa Salmanoğlu, Özgür Canoler, Nedim Çekmen, Canan Kandaz, Gülşen Bulut Kaya, Melis Türker, İlknur Şeker, Aysu Hayriye Tezcan, Halil İbrahim Uzunlar, Mehmet Akif Yazar, Reyhan Arslantaş, Nalan Adıgüzel, Murat Aksun, Okay Öztürk, Zakir Arslan, Özgür Özmen, Günseli Orhun, Evren Büyükfırat, Oya Çimen Budur, Mehmet Erdem Akçay, Asu Özgültekin, Ertuğrul Kılıç, Makbule Elif Yılmaz, Ömür İlban, Feyza Kargın, Murat Sayın, Feyza Kargın, Resul Altuntaş, Hakan Doğan, Osman Ekinci, Berna Çalışkan, Ayşen Erdoğan, Volkan Alparslan, Murat Tekin

Abstract

Background: The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey.

Methods: A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded.

Results: Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1:4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients.

Conclusions: A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.

Trial registration: ClinicalTrials.gov ID NCT03249246 . Date: August 15, 2017. Retrospectively registered.

Keywords: Carbapenem resistance; Intensive care; Point prevalence; Sepsis; Turkey.

Conflict of interest statement

Ethics approval and consent to participate

The Kocaeli University Ethics Committee and Review Board approved the study for all participating centers (Reference number: KOÜKAEK 2016/2). Informed consent was obtained from all participants or their legally acceptable representatives.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of study participants. ICU intensive care unit, SIRS systemic inflammatory response syndrome.,*Following exclusion of cardiovascular, coronary, and pediatric ICUs
Fig. 2
Fig. 2
Antibiotic susceptibility pattern of microorganisms and survival status at 30 days. Mortality ratio was not different among antibiotic-sensitive and -resistant strains when evaluated by chi-squared test. *p = 0.832, compared with carbapenem-sensitive Acinetobacter spp. ‡p = 0.970, compared with carbapenem-sensitive Pseudomonas spp. #p = 0.595, compared with carbapenem-sensitive Klebsiella spp. &p = 0.474, compared with methicillin-sensitive S. aureus

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