Current practice of management of bacteremic sepsis: a study in a tertiary care teaching hospital in Japan.
OBJECTIVE
To investigate how patients with bacteremic sepsis are managed in a tertiary care teaching hospital.


METHODS
Prospective observational study on patients with bacteremic sepsis. Clinical and microbiological characteristics of bacteremic sepsis were analyzed in relation to prognosis. Severity of the illness was quantitatively analyzed by the APACHE (Acute Physiology, Age, Chronic Health Evaluation) III scoring system. Also investigated was how closely physicians paid attention to acute physiological alterations in patients.


RESULTS
The 28-day mortalities in fifty hemodynamically stable patients and in twenty-three septic shock patients were 26% and 52%, respectively (p=0.028). Gram-positive organisms accounted for 54% of all organisms, with the mortality and incidence of septic shock being the same as with Gram-negative infections. The mean APACHE III score was 42.9 in survivors, and 76.5 in non-survivors (p < 0.001). Although serum levels of C-reactive protein and acute physiology score (APS) was significantly higher in non-survivors than in survivors, the correlation with APACHE III score was more prominent in APS. The number of vital signs recorded was 1.67 in physicians and 3.6 in nurses (p < 0.001).


CONCLUSIONS
The present study proved that the APACHE III score accurately discriminates between survivors and non-survivors of patients with sepsis. By addressing the need for an objective evaluation of severity of illness, it strongly recommends that physicians should be made aware of physiologically defined sepsis and that they should pay closer attention to patients' physiological alterations to identify the development of sepsis in critically ill patients.
Aoki
Y
Y
Department of Medicine, Saga Medical School.
Fukuoka
M
M
Kusaba
K
K
Tanabe
I
I
Nagasawa
Z
Z
Tominaga
M
M
Hayashi
S
S
Tadano
J
J
Nagasawa
K
K
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000097:blood / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies