title: A Comparative Study to Assess the Determinants and Outcomes of Sepsis Treated in Medical Wards and ICU in an Indian Teaching Hospital.
abstract: BACKGROUND
  Sepsis is the primary cause of death from infection worldwide. In resource-limited countries, increasing number of sepsis is managed in non-ICU settings, in Medical Wards (MW).
  
  
  OBJECTIVE
  To compare the burden, aetiology and short term outcome of sepsis treated in MW with ICU.
  
  
  METHODS
  Prospective, observational, analytical study in sepsis patients in general MW and medical ICU in a tertiary care hospital. Two hundred forty five sepsis patients (MW=150, ICU=95), ≥18 years, selected randomly, were studied to compare aetiology, co-morbidities, clinical & microbiological profile and short-term outcome between MW and ICU sepsis. Sepsis following surgery, trauma, those transferred to/from ICU, those with other life threatening diseases were excluded. Chi-square test/Fisher's-exact test was used for comparing ratios. A 'p-value' <0.05 was considered statistically significant.
  
  
  RESULTS
  Sepsis was more common in elderly males, both in MW and ICU (median age: 56.7, 59.2 years; male: female ratios = 1.34:1, 1.63:1 respectively). Frequency of presenting symptoms, co-morbidities and sources of sepsis were similar in both groups (p>0.05). Frequency of positive microbiological culture, pattern of microbial flora and antimicrobial resistance patterns were similar in both groups (p>0.05). Number of antibiotics used was significantly higher in ICU compared to MW (p<0.01); multi-organ dysfunction and mortality were significantly higher in ICU settings (55.8% vs. 38.7%, p=0.04; 48.4% vs. 32.6%, p=0.041 respectively). While sepsis and severe sepsis were significantly higher in MW (34.6% vs. 22.1 %, p=0.03; 47.3% vs. 26.3%, p<0.01 respectively), septic shock was significantly higher in ICU (51.6% vs. 18.0%, p<0.01). Mortality in both settings was highest in septic shock (55.5% and 61.2%, p>0.05) and multi-organ dysfunction (55.1% and 64.2%, p>0.05). Duration of hospital stay was significantly shorter in MW than ICU (7.3 vs. 11.0 days, p<0.01).
  
  
  CONCLUSIONS
  Our study aimed to identify determinants and outcome of sepsis in MW and compare with ICU settings. Antibiotic usage in the two settings differed: concurrent use of ≥3 antibiotics, and carbapenems & linezolid usage were significantly higher in ICU compared to MW. Sepsis in MW had significantly lower incidence of multi-organ failure, lower mortality and shorter hospital stay compared to ICU.
authors: Professor and Head, Department of Medicine, Guwahati Medical College , Guwahati, India .
authors: Prasanta Kumar
authors: PK
authors: Bhattacharya
authors: Postgraduate Student, Department of Medicine, Guwahati Medical College , Guwahati, India .
authors: Debdutta
authors: D
authors: Gautom
authors: Assistant Professor, Department of Medicine, Guwahati Medical College , Guwahati, India .
authors: Neena
authors: N
authors: Nath
authors: Senior Lecturer in Biostatistics, Department of Community Medicine, Assam Medical College , Dibrugarh, India .
authors: Hiranya
authors: H
authors: Saikia
keywords: Antibiotic resistance; Co-morbidities; Hospital stay; Mortality; Organ dysfunction; Sepsis syndromes