Dr Ho Chun Ming, Chris, ICU, North District Hospital, Date of submission: 20th March 2010
Dr CM Ho passed the Exit Examination of the Critical Care Medicine Specialty of The Hong Kong College of Physicians held on 15th May 2010. Congratulations! The following is the abstract of his dissertation.
Abstract
Objectives: To review the characteristics, outcomes, patterns of infection, and predictors of mortality in critically ill patients with sepsis from the Mainland China
Design: Retrospective cohort study
Setting: A regional hospital in Hong Kong
Patients: Critically ill patients who lived in the Mainland and were admitted to the Intensive Care Unit (ICU) of North District Hospital (NDH) from September 2007 to August 2009
Intervention: None
Measurements and Results: Eighty six patients (median age, 68 years) were analyzed. It accounts for 7.4% of our annual ICU admission. The APACHE II and SOFA scores were 24 and 11 respectively. 27.9% of these patients died before ICU and 47.7% died during their hospital stay. The median length of ICU and hospital stay was 6 and 22 days respectively. The most common cause of sepsis was respiratory infection (n=58, 67.4%). Pathogenic organisms can be identified in most of these patients (n=65, 75.6%). The most common organism was Escherichia coli. Poor prognostic factors included smoking habit, mechanical ventilator or vasopressors use from the Mainland, respiratory infection, mechanical ventilator support in our ICU and higher APACHE II / SOFA scores.
Conclusions: Sepsis is a common cause of intensive care admission among patients living in the Mainland with a significant mortality. The incidence of extended spectrum beta-lactamases (ESBL) producing enterobacteriaceae infection was high. Better understandings of their characteristics are important.
References
1. Survey of Hong Kong People Living in Shenzhen 2008.
2. Hotchkiss, R.S. and I.E. Karl, The pathophysiology and treatment of sepsis. N Engl J Med, 2003. 348(2): p. 138-50.
3. Angus, D.C., et al., Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med,
2001. 29(7): p. 1303-10.
4. Martin, G.S., et al., The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med, 2003. 348(16): p. 1546-54.
5. Padkin, A., et al., Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med, 2003. 31(9): p. 2332-8.
6. Martin, G.S., D.M. Mannino, and M. Moss, The effect of age on the development and outcome of adult sepsis. Crit Care Med, 2006. 34(1): p.
15-21.
7. Hong Kong Population Projections 2007-2036 Census and Statistics Department, HKSAR
8. Rivers, E., et al., Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001. 345(19): p. 1368-77.
9. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med, 1992. 20(6): p.
864-74.
10. Knaus, W.A., et al., APACHE II: a severity of disease classification system. Crit Care Med, 1985. 13(10): p. 818-29.
11. Vincent, J.L., et al., The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med, 1996. 22(7): p. 707-10.
12. Vincent, J.L., et al., Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med, 1998. 26(11): p. 1793-800.
13. Moreno, R., et al., The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre
study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med, 1999. 25(7): p. 686-96.
14. Alberti, C., et al., Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med, 2002. 28(2): p. 108-21.
15. Finfer, S., et al., Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med, 2004. 30(4): p. 589-96.
16. Opal, S.M., The uncertain value of the definition for SIRS. Systemic inflammatory response syndrome. Chest, 1998. 113(6): p. 1442-3.
17. Vincent, J.L., Sepsis definitions. Lancet Infect Dis, 2002. 2(3): p. 135.
18. Abraham, E., et al., Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: time for a
reevaluation. Crit Care Med, 2000. 28(1): p. 232-5.
19. Vincent, J.L., Dear SIRS, I’m sorry to say that I don’t like you. Crit Care Med, 1997. 25(2): p. 372-4.
20. Brun-Buisson, C., et al., EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med,
2004. 30(4): p. 580-8.
21. Bruunsgaard, H., et al., Elderly humans show prolonged in vivo inflammatory activity during pneumococcal infections. J Infect Dis, 1999. 180(2): p. 551-4.
22. Schroder, J., et al., Gender differences in human sepsis. Arch Surg, 1998. 133(11): p. 1200-5.
23. Crabtree, T.D., et al., Gender-dependent differences in outcome after the
treatment of infection in hospitalized patients. Jama, 1999. 282(22): p. 2143-8.
24. Eachempati, S.R., L. Hydo, and P.S. Barie, Gender-based differences in outcome in patients with sepsis. Arch Surg, 1999. 134(12): p. 1342-7.
25. Peckova, M., et al., Weekly and seasonal variation in the incidence of cardiac arrests. Am Heart J, 1999. 137(3): p. 512-5.
26. Lanska, D.J. and R.G. Hoffmann, Seasonal variation in stroke mortality rates. Neurology, 1999. 52(5): p. 984-90.
27. Danai, P.A., et al., Seasonal variation in the epidemiology of sepsis. Crit Care Med, 2007. 35(2): p. 410-5.
28. Alberti, C., et al., Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients. Am J Respir Crit Care Med, 2003. 168(1): p. 77-84.
29. Bagshaw, S.M., et al., Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol, 2007. 2(3): p.
431-9.
30. Wong, D.T., et al., Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med,
1995. 23(7): p. 1177-83.
31. Levy, M.M., et al., The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 38(2): p. 367-74.
32. Vincent, J.L., et al., Sepsis in European intensive care units: results of the SOAP study. Crit Care Med, 2006. 34(2): p. 344-53.
33. Brun-Buisson, C., et al., Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. Jama, 1995. 274(12): p. 968-74.
34. Brun-Buisson, C., The epidemiology of the systemic inflammatory response. Intensive Care Med, 2000. 26 Suppl 1: p. S64-74.
35. Ho, P.L., et al., Comparison of screening methods for detection of extended-spectrum beta-lactamases and their prevalence among Escherichia
coli and Klebsiella species in Hong Kong. Apmis, 2000. 108(3): p. 237-40.
36. Dai, C.M., et al., [Distribution of pathogen and resistance of nosocomial infections in the intensive care units]. Zhong Nan Da Xue Xue Bao Yi Xue Ban,
2006. 31(2): p. 277-80.
37. Wang, H. and M. Chen, Surveillance for antimicrobial resistance among clinical isolates of gram-negative bacteria from intensive care unit patients in China, 1996 to 2002. Diagn Microbiol Infect Dis, 2005. 51(3): p. 201-8.
38. Xiong, Z., et al., Investigation of extended-spectrum beta-lactamase in Klebsiellae pneumoniae and Escherichia coli from China. Diagn Microbiol
Infect Dis, 2002. 44(2): p. 195-200.
39. Peter Foster, China threatens world health by unleashing waves of superbug. Telegraph 7th Feb 2010.
40. Ryu, Y.J., et al., Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure. Respirology, 2007. 12(3): p. 406-11.
41. Ho, P.L., et al., Fecal carriage of CTXM type extended-spectrum beta-lactamase-producing organisms by children and their household contacts. Journal of Infection, 2010. 60(4):p. 286-292