Transcript Slide 1

Presence of Sepsis in
Republic of Macedonia
Panova G., Zisovska E., Zdravkova V. Panova B.
PanovN. Stojanov H. Nikolovska L. Shumanov G.
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Bacterial sepsis is a clinical term used to
describe symptomatic bacteremia, with or
without organ dysfunction. Currently,
sepsis is commonly defined as the
presence of infection in conjunction with
the systemic inflammatory response
syndrome (SIRS), with severe sepsis
understood as sepsis complicated by organ
dysfunction and septic shock understood
as sepsis-induced acute circulatory failure
characterized by persistent arterial
hypotension despite adequate volume
resuscitation and not explained by other
causes.[2]
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The term sepsis is often misused and
misapplied to patients with fever,
leukocytosis, and hypotension due to other
causes (pseudosepsis). True sepsis is a
common cause of hospitalization in almost
all countries, including in elderly men who
are more likely to develop urosepsis as a
result of benign urinary tract
obstruction caused by prostatic
hypertrophy. Patients who have diabetes,
systemic lupus erythematosus (SLE), or
alcoholism or who are taking steroids are
also at increased risk for bacteremia.
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Sustained bacteremia, in contrast to transient
bacteremia, may result in a sustained febrile
response that may be associated with organ
dysfunction. The term septicemia refers to the
active multiplication of bacteria in the
bloodstream that results in an overwhelming
infection; the term bloodstream infection (BSI)
is also commonly used.
The most important medicolegal concerns
regarding sepsis treatment include the
following:
Ensuring that the patient indeed does have
sepsis
Rapidly identifying its source
Implementing effective treatments
 Most
cases of sepsis occur as a result
of infection of the urinary tract, lungs
or peritoneum . Other sources of
infection include skin infections, soft
tissues and the central nervous
system. Approximately 50 % of cases
of sepsis caused by gram - negative
bacteria, and less than 50 % are
caused by gram-positive bacteria.
Less common causes of sepsis are
bacterial infections and viruses such
as HIV and protozoa.
 Sepsis
or septic shock may be
associated with the direct
introduction of microbes into the
bloodstream via intravenous (IV)
infusion (eg, IV line infections and
other
device-associated infections).
Meningococcemia from a
respiratory source may also result
in sepsis, with or without
associated meningitis.
 Bacteriemia
due to bacteriuria
(urosepsis) may complicate cystitis in
compromised hosts, and sepsis may
be caused by overwhelming
pneumococcal infection in patients
with impaired or absent splenic
function.[5]
 The pathophysiology of sepsis is
complex and results from the effects
of circulating bacterial products,
mediated by cytokine release, caused
by sustained bacteremia.
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Cytokines are responsible for the clinically
observable effects of the bacteremia in the
host.[6,7,8,9] Impaired pulmonary, hepatic, or renal
function may result from excessive cytokine
release during the septic process.
Multiple organ dysfunction syndrome (MODS) is a
continuum, with incremental degrees of
physiologic derangements in individual organs; it
is a process rather than a single event. Alteration
in organ function can vary widely from a mild
degree of organ dysfunction to completely
irreversible organ failure. The degree of organ
dysfunction has a major clinical impact.
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In a classic 1975 editorial by Baue, the
concept of “multiple, progressive or
sequential systems failure” was formulated
as the basis of a new clinical
syndrome.[1] Several different terms were
proposed thereafter (eg, multiple organ
failure, multiple system organ failure, and
multiple organ system failure) to describe
this evolving clinical syndrome of
otherwise unexplained progressive
physiologic failure of several
interdependent organ systems.
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Eventually, the term MODS was proposed as a more
appropriate description. MODS is defined as a
clinical syndrome characterized by the
development of progressive and potentially
reversible physiologic dysfunction in 2 or more
organs or organ systems that is induced by a
variety of acute insults, including sepsis.
Sepsis is a clinical syndrome that complicates
severe infection and is characterized by systemic
inflammation and widespread tissue injury. A
continuum of severity from sepsis to septic shock
and MODS exists. The clinical process usually
begins with infection, which potentially leads to
sepsis and organ dysfunction.[2] A consensus panel
of the American College of Chest Physicians and
the Society of Critical Care Medicine developed
definitions of the various stages of this process. [3]
 Infection
is a microbial
phenomenon in which an
inflammatory response to the
presence of microorganisms or
the invasion of normally sterile
host tissue by these organisms is
characteristic.
 Bacteremia is the presence of
viable bacteria in the blood.
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Systemic inflammatory response syndrome (SIRS)
may follow a variety of clinical insults, including
infection, pancreatitis, ischemia, multiple trauma,
tissue injury, hemorrhagic shock, or immunemediated organ injury. SIRS is defined by the
presence of 2 or more of the following:
Temperature greater than 38.0°C or less than
36.0°C
Heart rate higher than 90 beats/min
Respiratory rate higher than 20 breaths/min or
arterial carbon dioxide tension below 32 mm Hg
White blood cell (WBC) count higher than
12,000/µL, lower than 4000/µL, or including more
than 10% bands
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Sepsis is a systemic response to infection. It is
identical to SIRS, except that it must result
specifically from infection rather than from any of
the noninfectious insults that may also cause SIRS
(see the image below).
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Sepsis is a common cause of mortality and
morbidity worldwide. The prognosis
depends on underlying health status and
host defenses, prompt and adequate
surgical drainage of abscesses, relief of
any obstruction of the intestinal or urinary
tract, and appropriate and early empiric
antimicrobial therapy with the drug
spectrum appropriate to the presumed
septic source. Thus, early and appropriate
empiric antimicrobial therapy and surgical
intervention are critical in decreasing
mortality and morbidity.
The prognosis in most patients is good,
except in those with intra-abdominal or
pelvic abscesses due to organ perforation.
The underlying physiologic condition of
the host is the primary determinant of
outcome.
 A systematic review by Winters et al
suggested that beyond the standard 28day in-hospital mortality endpoint,
ongoing mortality in patients with sepsis
remains elevated up to 2 years and
beyond.[10] In addition, survivors
consistently demonstrate impaired quality
of life.[11]
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 Purpose
of the study:
 Taking into consideration the severe
consequences of sepsis and septic
shock, the aim of this study was to
evaluate the statistical reports on the
number of cases of sepsis, increased
morbidity and mortality and causes of
their occurrence, in order to give a
contribution in any segment of the
problems associated with this disease,
and their impact on patients and staff
working in health facilities.
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Material and methods :Statistical data
obtauined by the Institute of Public health
in Skopje was analyzed and processed. In
order to answer the questions formulated
as a goal of this effort, the analyzis was
performed showing the trends of sepsis
and the number of the cases in Macedonia
through statistical data processing. In the
preparation of this paper descriptive
method was applied through collection and
processing of data tables showing the
results.
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Results: The results of the Institute of
Public helath in Skopje (Republic of
Macedonia) with encrypted diagnosis from
2012 godina, as A40 and A41 (septicemia),
75 people were treated with these codes
and diagnosis, of whom 54 were men, 21
were women, at the age from 0-89 years.
On average, they were treated about 15
days, and all of them (75 patients) had
1130 hospital days. The average length of
stay was 15,07 days. Patients were from
Prilep, Ohrid, Tetovo, Kavadarci, Kocani,
and Strumica.
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Patients were treated in the following
hospitals: The Special hospital KozleSkopje, Clinic for Childfren’s diseases, the
Departments of Infeciytous diseases , the
City Hospital 8mi Septemvri – Skopje, and
the most severe cases 35/75) were treated
at the Clinic for Infectious Diseases-Skopje
– Skopje. All these cases have endangered
the health of the patients and were great
therats to their lives. The probable source
of the sepsis was uroinfection in 37%, 29%
were abdominal infections, 12% were skin
infections, and the rest had unclear
(unconfirmed) origin.
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Discussion: Centers for Public Health and
their organizational units perform regular
activities in collecting data about the septic
cases in the country. During the data
collection in 2012 in the Republic of
Macedonia regarding the implementation
of measures and activities to monitor,
prevent and suppress the occurrence of
sepsis in medical facilities on its territory,
they have recorded (reported to them) the
presented 75 cases.
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The Institute for Public Health - Skopje received
written reports, information and therefore
published the Annual reports (specific or
aggregated), compared by year, and presenting the
trends. This kind of activity is very important for
the country in the process of the follow uo of this
very dangerous state of ill/health. Deeper analysis
is necessary to find out the causes of sepsis, the
source of infection and to plan measures of
prevention, in terms of improving the health and
prevention of nosocomial infections which are
usually the main mode of systemic infections. The
special attention should be put in the Intensive
care units in the country.
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Conclusion: Sterilization and the insuficient
preventive measures are still unsatisfactory in
Macedonian health institutions. It is unacceptable
in the 21st century sepsis to be the cause of
serious complications in patients . Sepsis pose a
very serious problem in the world and in our
country, and in many cases more difficult problem
than the patient's underlying disease. Thes sepsis
appearance is directly related to medical
procedures for diagnostic studies, treatment,
health care, rehabilitation, and other health care
procedures .
 On
September 13, the World
Day
Sepsis would die ten times
greater than that of a heart
attack:is why it is important to
know.
Little known, diagnosed with
difficulty, it is actually one of
the most common and deadly
diseases.
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