Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/32808
Title: Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case-control study.
Austin Authors: Zampieri, Fernando G;Cavalcanti, Alexandre B;Taniguchi, Leandro U;Lisboa, Thiago C;Serpa Neto, Ary ;Azevedo, Luciano C P;Nassar, Antonio Paulo;Miranda, Tamiris A;Gomes, Samara P C;de Alencar Filho, Meton S;da Silva, Rodrigo T Amancio;Lacerda, Fabio Holanda;Veiga, Viviane Cordeiro;de Oliveira Manoel, Airton Leonardo;Biondi, Rodrigo S;Maia, Israel S;Lovato, Wilson J;de Oliveira, Claudio Dornas;Pizzol, Felipe Dal;Filho, Milton Caldeira;Amendola, Cristina P;Westphal, Glauco A;Figueiredo, Rodrigo C;Caser, Eliana B;de Figueiredo, Lanese M;de Freitas, Flávio Geraldo R;Fernandes, Sergio S;Gobatto, Andre Luiz N;Paranhos, Jorge Luiz R;de Melo, Rodrigo Morel V;Sousa, Michelle T;de Almeida, Guacyra Margarita B;Ferronatto, Bianca R;Ferreira, Denise M;Ramos, Fernando J S;Thompson, Marlus M;Grion, Cintia M C;Santos, Renato Hideo Nakagawa;Damiani, Lucas P;Machado, Flavia R
Affiliation: HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil.
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, AB, T6G2B7, Canada.
Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.;Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
Unidade de Terapia Intensiva, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.;Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.;Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.;Intensive Care Unit, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
Intensive Care Unit, AC Camargo Cancer Center, São Paulo, SP, Brazil.
Intensive Care
Hospital Maternidade São Vicente de Paulo, Barbalha, CE, Brazil.
Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
Hospital da Luz, São Paulo, SP, Brazil.
BP-A Beneficência Portuguesa de São Paulo, Sao Paulo, SP, Brazil.
Hospital Paulistano, São Paulo, SP, Brazil.
Instituto de Cardiologia do Distrito Federal, Brasilia, DF, Brazil.
HCor Research Institute, Rua Desembargador Eliseu Guilherme, 200, 8th Floor, São Paulo, Brazil.;Hospital Nereu Ramos, Florianópolis, SC, Brazil.;Hospital Baía Sul, Florianópolis, SC, Brazil.
Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
Santa Casa de Misericórdia Belo Horizonte, Belo Horizonte, MG, Brazil.
Hospital São José, Criciúma, SC, Brazil.
Hospital Dona Helena, Joinville, SC, Brazil.
Hospital de Amor-Fundação PIO XII, Barretos, SP, Brazil.
Centro Hospitalar Unimed, Joinville, SC, Brazil.
Hospital Maternidade São José, Colatina, ES, Brazil.
Hospital Unimed Vitória, Vitória, ES, Brazil.
Hospital Distrital Evandro Ayres de Moura Antônio Bezerra, Fortaleza, CE, Brazil.
Hospital e Maternidade Sepaco, Sao Paulo, SP, Brazil.;Department of Anesthesiology, Pain and Critical Care-Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil.
Hospital Japones Santa Cruz, Sao Paulo, SP, Brazil.
Hospital da Cidade, Salvador, BA, Brazil.
Santa Casa de Misericórdia de São João Del Rei, Belo Horizonte, MG, Brazil.
Hospital Ana Nery, Salvador, BA, Brazil.
Fundação São Francisco de Assis, Belo Horizonte, MG, Brazil.
Hospital Regional Dr. Clodolfo Rodrigues de Melo, Maceio, AL, Brazil.
Hospital Erasto Gaertner, Curitiba, PR, Brazil.
Hospital das Clínicas da Universidade Federal de Goiás, Goiânia, GO, Brazil.
BP-A Beneficência Portuguesa de São Paulo, Sao Paulo, SP, Brazil.
Hospital Evangélico de Cachoeiro de Itapemirim, Cachoeiro de Itapemirim, ES, Brazil.
Hospital Universitário Regional do Norte do Paraná, Londrina, PR, Brazil.
Department of Anesthesiology, Pain and Critical Care-Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil.
Issue Date: 26-Apr-2023
Date: 2023
Publication information: Annals of Intensive Care 2023; 13(1)
Abstract: Nosocomial sepsis is a major healthcare issue, but there are few data on estimates of its attributable mortality. We aimed to estimate attributable mortality fraction (AF) due to nosocomial sepsis. Matched 1:1 case-control study in 37 hospitals in Brazil. Hospitalized patients in participating hospitals were included. Cases were hospital non-survivors and controls were hospital survivors, which were matched by admission type and date of discharge. Exposure was defined as occurrence of nosocomial sepsis, defined as antibiotic prescription plus presence of organ dysfunction attributed to sepsis without an alternative reason for organ failure; alternative definitions were explored. Main outcome measurement was nosocomial sepsis-attributable fractions, estimated using inversed-weight probabilities methods using generalized mixed model considering time-dependency of sepsis occurrence. 3588 patients from 37 hospitals were included. Mean age was 63 years and 48.8% were female at birth. 470 sepsis episodes occurred in 388 patients (311 in cases and 77 in control group), with pneumonia being the most common source of infection (44.3%). Average AF for sepsis mortality was 0.076 (95% CI 0.068-0.084) for medical admissions; 0.043 (95% CI 0.032-0.055) for elective surgical admissions; and 0.036 (95% CI 0.017-0.055) for emergency surgeries. In a time-dependent analysis, AF for sepsis rose linearly for medical admissions, reaching close to 0.12 on day 28; AF plateaued earlier for other admission types (0.04 for elective surgery and 0.07 for urgent surgery). Alternative sepsis definitions yield different estimates. The impact of nosocomial sepsis on outcome is more pronounced in medical admissions and tends to increase over time. The results, however, are sensitive to sepsis definitions.
URI: https://ahro.austin.org.au/austinjspui/handle/1/32808
DOI: 10.1186/s13613-023-01123-y
ORCID: 
Journal: Annals of Intensive Care
Start page: 32
PubMed URL: 37099045
Type: Journal Article
Subjects: Attributable mortality
Epidemiology
Sepsis
Appears in Collections:Journal articles

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