The epidemiology and characteristics of sepsis in Norwegian hospitals
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Background: Sepsis develops when the host’s immune response to infection becomes dysregulated to such an extent that life-threatening organ dysfunction evolves. Sepsis epidemiology is influenced by population characteristics, environmental factors, and the occurrence and seasonal spread of pathogens. Thus, local knowledge in this field is highly desirable. With this thesis, we aimed to investigate the epidemiology and characteristics of sepsis in Norwegian hospitals from both a local and a national perspective.
Methods: Paper I and II are based on an observational survey of prospectively enrolled patients with community acquired sepsis at Haukeland University hospital in Bergen, Norway during the year 2008. Paper III is a retrospective, register based, nationwide study on patients hospitalized with sepsis throughout the years 2011 and 2012. It was performed by use of two databases containing hospitalization and general population data respectively; the Norwegian Patient Registry and Statistics Norway. Main results: In paper I, the incidence of community acquired sepsis was estimated, the underlying infectious sources and microbial etiologies were presented, and the precision of clinical diagnostics as well as the compliance with local therapy recommendations were evaluated. In paper II, community acquired sepsis patients treated in an intensive care unit were compared with a cohort receiving treatment at a lower care level. Independent predictors for long-term survival up to five years after hospitalization were investigated. In paper III, the demographics of Norwegian sepsis patients were explored, the annual population incidence of sepsis was calculated, and the fraction of sepsis hospitalizations among all somatic hospital admissions was estimated. Finally, the impact of sepsis on all-cause mortality in Norwegian hospitals was assessed.
Conclusion: This thesis demonstrates that sepsis is frequent in Norway, most prevalent among the elderly, and significantly more common among men than women. A large proportion of sepsis patients never receive intensive care treatment. Areas that need improvement are especially the identification and initial handling of less frequent infections. Further, the choice of empirical antimicrobial treatment regimens should be in greater concordance with local sepsis guidelines, in particular for the oldest patients. Sepsis is either the cause of or a contributing factor to a large number of Norwegian hospital deaths. Consequently, improvements in treatment could significantly influence population mortality in the future.