Sepsis in surgical inpatients: under-recognised but with significant consequences
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ORIGINAL ARTICLE
Sepsis in surgical inpatients: under-recognised but with significant consequences Aoife Reilly 1 & Ali Basil Ali 1 & Mairead Skally 2 & Leah Gaughan 3 & Vida Hamilton 4 & Alexandra Troy 5 & Hilary Humphreys 1,2 & Deborah McNamara 5 & Fidelma Fitzpatrick 1,2 Received: 5 April 2020 / Accepted: 23 September 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background The true incidence of sepsis in surgical cohorts in Ireland remains unclear. According to inpatient audits, patients in surgical diagnostic groups (DRG) who developed sepsis had a longer length of stay and higher mortality rate compared with medical DRG patients who developed sepsis. Aims We investigated sepsis incidence on a general surgical ward to identify risk factors and strategies to improve management. Methods Demographics, admission and discharge details, infection risk factors, infection, and sepsis were studied prospectively on a surgical ward in July 2018. Results The mean age of 164 patients was 60.5 years (range 18–93 years), 107 (65.2%) were admitted electively, 16 (9.8%) were colonised with a multidrug-resistant organism (MDRO), and 30 (18.3%) were classified as frail on admission. Twelve (7.3%) developed sepsis (ward sepsis rate 118.2/10,000 bed days used). ‘Sepsis’ was documented in six cases and the national sepsis screening form used in four patients. Patients with sepsis were three times as likely to be MDRO-colonised (OR 3.56; 95% CI = 0.86–14.82; p = 0.065) or frail (OR 3.63; 95% CI = 1.07–12.35; p = 0.03), four times as likely to be an inpatient at the end of the study (OR 4.22, 96% CI 1.23–14.49; p = 0.01), and three times as likely to be readmitted (OR 3.46, 95% CI 1.02–11.76; p = 0.03). Conclusion Sepsis was under-documented, and barriers exist with use of the national sepsis screening form. Frailty, which is a sepsis risk factor, should be assessed pre-operatively to maximise prevention. Keywords Frailty . General surgery . Sepsis . Surgical inpatients
* Aoife Reilly [email protected]
Deborah McNamara [email protected]
Ali Basil Ali [email protected] Mairead Skally [email protected]
Fidelma Fitzpatrick [email protected] 1
Department of Clinical Microbiology, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
2
Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland
3
Department of Pharmacy, Beaumont Hospital, Dublin 9, Ireland
Alexandra Troy [email protected]
4
Department of Anaesthesia & Intensive Care, University College Hospital, Waterford, Ireland
Hilary Humphreys [email protected]
5
Department of Surgery, Beaumont Hospital, Dublin 9, Ireland
Leah Gaughan [email protected] Vida Hamilton [email protected]
Ir J Med Sci
Introduction Sepsis, if not recognised early, can lead to significant morbidity and mortality. In 2016, the definition of sepsis changed from the presence of a systemic inflammatory response (SIRS) due to infection (‘Sepsis-2’), to the ‘Sepsis-3’ definitions (organ dysfunction caused by a dysregulated immune res
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