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Attributable mortality due to nosocomial sepsis in Brazilian hospitals: a case–control study

2023; Springer Nature; Volume: 13; Issue: 1 Linguagem: Inglês

10.1186/s13613-023-01123-y

2110-5820

Fernando G. Zampieri, Alexandre Biasi Cavalcanti, Leandro Utino Taniguchi, Thiago Lisboa, Ary Serpa Neto, Luciano C. P. Azevedo, Antônio Paulo Nassar, Tamiris Abait Miranda, Samara P. C. Gomes, Meton Soares de Alencar Filho, Rodrigo T. Amancio da Silva, Fábio Holanda Lacerda, Viviane Cordeiro Veiga, Airton Leonardo de Oliveira Manoel, Rodrigo Biondi, Israel Silva Maia, Wilson José Lovato, Cláudio Dornas de Oliveira, Felipe Dal‐Pizzol, Milton Caldeira Filho, Cristina Prata Amêndola, Glauco Adrieno Westphal, Rodrigo C. Figueiredo, Eliana Bernadete Caser, Lanese Medeiros de Figueiredo, Flávio Geraldo Rezende Freitas, Sergio Sonego Fernandes, André Luiz Nunes Gobatto, Jorge L. R. Paranhos, Rodrigo Morel V. de Melo, Michelle Tereza Sousa, Guacyra Margarita Batista de Almeida, Bianca Ramos Ferronatto, Denise Milioli Ferreira, Fernando J. S. Ramos, Marlus M. Thompson, Cíntia Magalhães Carvalho Grion, Renato Hideo Nakagawa Santos, Lucas Petri Damiani, Flávia Ribeiro Machado, Bárbara Macedo, Fabio S. Coutinho, Jussara A. Arraes, Viviane S. N. Xavier, Eliana V. N. Martins, Juliana Chaves Coelho, Silvana Soares dos Santos, Andréia Pardini, Cássio Luis Zandonai, Julia B. de Carvalho, Isabela O. B. Louredo, Renata C. Gonçalves, Micheli C. Arruda, Mariana Regina da Cunha, Mariana Bonomini F. de Almeida, Juliano Ramos, Bruna M. Binda, Priscila L. S. Almeida, Marcia Maria R. de Oliveira, Luciana S. de Mattos, Samara G. da Silva, Daniela C. Dorta, Martha Hadrich, Fernanda Alves Ferreira Gonçalves, Kaytiussia R. de Sena, Pamella M. dos Prazeres, Josiane Festti,

Antibiotic Use and Resistance

Abstract Background 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. Methods 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. Results 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. Conclusion 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.