Primary infections of the bloodstream (CI) are a leading infectious complication in patients in the intensive care unit and the intensive care unit (ICU). RI occurs in 15% of all patients with nosocomial infections and in 1% of all hospitalized patients. Detection of IR is an unfavorable prognostic factor for the outcome of the disease. CI increases mortality, length of hospital stay in the ICU and hospital, as well as the cost of stay in a medical establishment. When monitoring infections, primary IRs are characterized as "microbiologically confirmed infections", unlike sepsis, which is diagnosed based on clinical laboratory settings and in which the pathogen often fails to be isolated. The epidemiology of clinically diagnosed sepsis is not well understood. At the same time, the selected monitoring of sepsis, diagnosed only on the basis of laboratory parameters, does not allow us to fully assess the prevalence and epidemiological significance of primary infections of the bloodstream.

Study the prevalence of clinically diagnosed sepsis from October 1995 to November 1997. A research team led by Dr. S. Hugonnet monitored all infections in an 18-bed intensive care unit, located at the University Hospital of Geneva Switzerland. Each year, 1,400 patients are hospitalized in the service; the average length of hospital stay is 4 days.

According to the protocol, a nurse from the infection control group visited the ICU daily (5 days a week) and collected information from case history and prescription cards, data from microbiological studies and and also interviewed nurses and emergency physicians on duty. The study included all patients who were in intensive care for more than 48 hours and were observed within 5 days after discharge from intensive care. The diagnosis of nosocomial infection was made according to the criteria of the Centers for Disease Control and Prevention (CDC), Atlanta, USA. The parameters studied were all nosocomial infections, patient demographic characteristics, clinical diagnosis on admission and discharge, the presence of invasive equipment (vascular catheters, probes, mechanical ventilation), antibiotic therapy, as well as survival in ICU and hospital.

Clinical sepsis has been recorded if the patient had fever or hypotension or oliguria in combination with all of the following symptoms:

In total, the study included 1068 patients who were in intensive care for more than 48 hours with an average hospital stay of 5 days (2-134). The main diagnoses at admission were various infections (38.7%), cardiovascular pathology (24.2%) and respiratory tract pathology (17.7%). A total of 554 infections developed in the ICU were recorded during the follow-up period. The infection rate was 71 episodes per 1000 patient days (95% CI). The main sources of infection were the lungs (pneumonia - 28.7%), blood circulation infections (20.4%), skin and soft tissue infections (15.3%), vascular catheters (13.5%) and urinary tract infections (11.2%).

Out of 113 episodes of primary blood infections, 33 (29.2%) successfully isolated the pathogen, that is, they were found to be "microbiologically confirmed" and 80 (70.8%) were sepsis, confirmed by changes in clinical laboratory settings. Blood cultures have been studied in most cases of clinically confirmed sepsis (66/80, 82.5%). Empirical antibacterial therapy before blood culture was prescribed in 39.4% (13/33) of patients with microbiologically confirmed IR and in 77.3% (51/66) of patients with clinical sepsis (p less than 0.001). Among 20 patients with microbiologically confirmed IR who did not receive antibiotics for 48 hours before taking blood samples, 6 patients were in the therapeutic window (antibiotic therapy was suspended until blood samples be taken to increase the sensitivity of the blood culture test).

The mean length of hospital stay was longer in patients with microbiologically confirmed IR (15.5 days, 4-67 days) and clinical sepsis (14.0 days, 3-48 days) compared to patients without IR (4 days, 2-134 days)), (p less than 0.001). Hospital mortality in patients without CI, with microbiologically confirmed CI and with clinical sepsis was 22.7%, 32.1% and 39.7%, respectively. Statistical significance was established for patients in the first and last groups (p less than 0.01).

The most common nosocomial infections complicated by microbiologically confirmed blood circulation infections and clinical sepsis were pneumonia (45% and 30%), urinary tract infections (15% and 15%), catheter-associated infections ( 4% and 23%) and other infections (33% and 39%).

On the basis of the data obtained, the authors conclude that clinical sepsis is an epidemiologically significant syndrome. Further development of surveillance strategies for this nosology is necessary for prevention, evaluation of prevalence and improvement of the quality of treatment, based on the results of surveillance.