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Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study.
BMC Anesthesiol 2019; 19(1):185BA

Abstract

BACKGROUND

Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis.

METHODS

A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively.

RESULTS

A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90.

CONCLUSIONS

Urinary and deep venous catheterization increased the risk of secondary infection, in which underlying immunosuppression might also play a role. Secondary infection affected the prognosis of septic patients and prolonged in-hospital length of stay.

Authors+Show Affiliations

Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.Department of Pharmacology, University of Virginia School of Medicine, Charlottesville, Virginia, 22908, USA.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. song.zhenju@zs-hospital.sh.cn.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. tong.chaoyang@zs-hospital.sh.cn.Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. du.shilin@zs-hospital.sh.cn.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31627725

Citation

Chen, Yao, et al. "Clinical Characteristics, Risk Factors, Immune Status and Prognosis of Secondary Infection of Sepsis: a Retrospective Observational Study." BMC Anesthesiology, vol. 19, no. 1, 2019, p. 185.
Chen Y, Hu Y, Zhang J, et al. Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study. BMC Anesthesiol. 2019;19(1):185.
Chen, Y., Hu, Y., Zhang, J., Shen, Y., Huang, J., Yin, J., ... Du, S. (2019). Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study. BMC Anesthesiology, 19(1), p. 185. doi:10.1186/s12871-019-0849-9.
Chen Y, et al. Clinical Characteristics, Risk Factors, Immune Status and Prognosis of Secondary Infection of Sepsis: a Retrospective Observational Study. BMC Anesthesiol. 2019 Oct 18;19(1):185. PubMed PMID: 31627725.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study. AU - Chen,Yao, AU - Hu,Yanyan, AU - Zhang,Jin, AU - Shen,Yue, AU - Huang,Junling, AU - Yin,Jun, AU - Wang,Ping, AU - Fan,Ying, AU - Wang,Jianli, AU - Lu,Su, AU - Yang,Yilin, AU - Yan,Lei, AU - Li,Keyong, AU - Song,Zhenju, AU - Tong,Chaoyang, AU - Du,Shilin, Y1 - 2019/10/18/ PY - 2018/12/23/received PY - 2019/09/13/accepted PY - 2019/10/20/entrez PY - 2019/10/20/pubmed PY - 2019/10/20/medline KW - Cytokine KW - HLA-DR KW - Immunosuppression KW - Secondary infection KW - Sepsis SP - 185 EP - 185 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 19 IS - 1 N2 - BACKGROUND: Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis. METHODS: A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively. RESULTS: A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90. CONCLUSIONS: Urinary and deep venous catheterization increased the risk of secondary infection, in which underlying immunosuppression might also play a role. Secondary infection affected the prognosis of septic patients and prolonged in-hospital length of stay. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/31627725/Clinical_characteristics,_risk_factors,_immune_status_and_prognosis_of_secondary_infection_of_sepsis:_a_retrospective_observational_study L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-019-0849-9 DB - PRIME DP - Unbound Medicine ER -