title: Epidemiology and microbiology of sepsis in mainland China in the first decade of the 21st century.
abstract: OBJECTIVE
  This study describes the epidemiological and microbiological profile of sepsis during the first decade of the 21(st) century in mainland China.
  
  
  METHODS
  The sepsis-related mortality data from 2003 and 2007 were retrieved from the China Health Statistical Yearbook. The microbiology data were retrieved and selected from a literature search of the China Academic Journal Database between 2001 and 2009. A meta-analysis was performed to synthesize the available data on the proportion of positive blood cultures in septic patients and the microorganism distribution.
  
  
  RESULTS
  The sepsis mortality in small and medium-sized cities and rural areas declined obviously over time. The mortality of the subpopulations aged 1-54 years tended to be lower than the national averages. In contrast, the sepsis mortality among neonates and the elderly (≥75 years) was obviously higher than national averages. While the mortality in the elderly declined between 2003 and 2007, the neonate sepsis mortality increased dramatically, especially among male neonates. The overall positivity of blood culture were 17.0%, 13.3% and 10.6% among neonatal, pediatric and adult patients with suspected sepsis, respectively; this proportion tended to decrease over time. Among identified microorganisms, the proportions of Gram (+) and (-) bacteria were similar (47.2% vs. 44.5%) among adult patients, while Gram (+) bacteria was predominant among neonatal (77.4%) and pediatric (73.2%) patients and increased in prevalence over time. The positivity of blood cultures and proportions of microorganisms varied by geographical region across mainland China. Sepsis with fungus was rare but was more prevalent in adult sepsis patients (6.4%) than in neonatal patients (0.8%).
  
  
  CONCLUSIONS
  The difference in sepsis mortality between urban and rural areas decreased over time. Males, the elderly, and neonates were found to be high-risk subpopulations. Gram (+) bacteria were predominant among neonates with sepsis, but the proportion of patients with Gram (+) or Gram (-) bacteria was similar among adults with sepsis.
authors.affiliation: Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xin-Chuan
authors.initials: XC
authors.lastname: Chen
authors.affiliation: Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yun-Fan
authors.initials: YF
authors.lastname: Yang
authors.affiliation: Nursing Section, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Hong-Feng
authors.initials: HF
authors.lastname: Gou
authors.affiliation: Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. Electronic address: chen_xz_wch_scu@126.com.
authors.forename: Xin-Zu
authors.initials: XZ
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality*; D055815:Young Adult
keywords: Bacteria; Epidemiology; Fungus; Microbiology; Mortality; Sepsis