THE SEPSIS SYNDROME IN A DUTCH UNIVERSITY HOSPITAL - CLINICAL OBSERVATIONS

Background: Most studies of the cause of sepsis syndrome focus on pati ents hospitalized in intensive care units. In this study, we analyzed the incidence, cause, and outcome of the sepsis syndrome in all hospit alized patients. Methods: Clinical and microbiologic data were obtaine d for 382 patients (5.6% of all patients admitted) from whom blood was drawn for culture. Results: The incidence of the sepsis syndrome was 13.6 per 1000 patients admitted (1.06 per 1000 hospital days), while t he incidence of septic shock was 4.6 per 1000. The respiratory tract w as the predominant infection site. Of all patients with sepsis syndrom e, 38% (n=35) had positive blood cultures. More than half of these cul tures (13 [57%]) were caused by gram-positive microorganisms (excludin g patients receiving selective decontamination of the digestive tract and those with intravascular device-related bacteremias). The mortalit y for patients with sepsis syndrome without shock was 28% (17/61), whi le for patients with septic shock, it was 55% (17/31). Patients with c ardiovascular diseases had a significantly (P<.005) greater risk of dy ing during a sepsis syndrome episode than patients with other predispo sing factors. Multivariate analysis of factors influencing outcome ide ntified the development of shock and an immunocompromised state as bei ng significantly associated with outcome in patients with sepsis syndr ome. Conclusions: Patients fulfilling the criteria for the sepsis synd rome are at great risk of developing septic shock or multiple-organ fa ilure and subsequently dying. In our hospital, the majority of bactere mic episodes were associated with gram-positive microorganisms.