EPIDEMIOLOGY OF SEPSIS SYNDROME IN 8 ACADEMIC MEDICAL-CENTERS

Context.-Sepsis syndrome is a leading cause of mortality in hospitaliz ed patients, However, few studies have described the epidemiology of s epsis syndrome in a hospitalwide population. Objective.-To describe th e epidemiology of sepsis syndrome in the tertiary care hospital settin g. Design.-Prospective, multi-institutional, observational study inclu ding 5-month follow-up. Setting.-Eight academic tertiary care centers. Methods.-Each center monitored a weighted random sample of intensive care unit (ICU) patients, non-ICU patients who had blood cultures draw n, and all patients who received a novel therapeutic agent or who died in an emergency department or ICU. Sepsis syndrome was defined as the presence of either a positive blood culture or the combination of fev er, tachypnea, tachycardia, clinically suspected infection, and any 1 of 7 confirmatory criteria. Estimates of total cases expected annually were extrapolated from the number of cases, the period of observation , and the sampling fraction. Results.-From January 4, 1993, to April 2 , 1994, 12 759 patients were monitored and 1342 episodes of sepsis syn drome were documented. The extrapolated, weighted estimate of hospital wide incidence (mean +/- 95% confidence limit) of sepsis syndrome was 2.0 +/- 0.16 cases per 100 admissions, or 2.8 +/- 0.17 per 1000 patien t-days. The unadjusted attack rate for sepis syndrome between individu al centers differed by as much as 3-fold, but after adjustment for ins titutional differences in organ transplant populations, variation from the expected number of cases was reduced to 2-fold and was not statis tically significant overall. Patients in ICUs accounted for 59% of tot al extrapolated cases, non-ICU patients with positive blood cultures f or 11%, and non-ICU patients with negative blood cultures for 30%. Sep tic shock was present at onset of sepsis syndrome in 25% of patients. Blood-stream infection was documented in 28%, with gram-positive organ isms being the most frequent isolates. Mortality was 34% at 28 days an d 45% at 5 months. Conclusions.-Sepsis syndrome is common in academic hospitals, although the overall rates vary considerably with the patie nt population. A substantial fraction of cases occur outside ICUs, An understanding of the hospitalwide epidemiology of sepsis syndrome is v ital for rational planning and treatment of hospitalized patients with sepsis syndrome, especially as new and expensive therapeutic agents b ecome available.