title: Incidence, risk factors and impact on outcomes of secondary infection in patients with septic shock: an 8-year retrospective study.
abstract: Secondary infection in septic patients has received widespread attention, although clinical data are still lacking. The present study was performed on 476 patients with septic shock. Time trends for mortality were analyzed using Spearman's rank correlation test. Risk factors for secondary infection were investigated by binary logistic regression. The extended Cox model with time-varying covariates and hazard ratios (HR) was performed to determine the impact of secondary infection on mortality. Differences in hospital length of stay (LOS) between patients with and without secondary infection were calculated using a multistate model. Thirty-nine percent of septic shock patients who survived the early phase of the disease developed secondary infection. There was a statistically significant increased odds ratio for secondary infection in older patients and patients with a longer LOS in the intensive care unit (ICU), a higher Sequential Organ Failure Assessment (SOFA) score, and endotracheal intubation. Secondary infection significantly reduced the rate of discharge (HR 5.607; CI953.612-8.704; P < 0.001) and was associated with an increased hospital LOS of 5.46 days. The present findings represent a direct description of secondary infection in septic shock patients and highlight the influence of this condition on septic shock outcomes.
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Guang-Ju
authors.initials: GJ
authors.lastname: Zhao
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhao
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Jia-Xing
authors.initials: JX
authors.lastname: Song
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Xiao-Rong
authors.initials: XR
authors.lastname: Chen
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Guang-Liang
authors.initials: GL
authors.lastname: Hong
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Meng-Fang
authors.initials: MF
authors.lastname: Li
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Bing
authors.initials: B
authors.lastname: Wu
authors.affiliation: Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, P.R.China.
authors.forename: Zhong-Qiu
authors.initials: ZQ
authors.lastname: Lu
mesh_terms: D018806:APACHE; D000368:Aged; D060085:Coinfection; D016638:Critical Illness; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D016019:Survival Analysis