Severe sepsis is a condition with significant morbidity, mortality and cost. Important resources are dedicated to manage elderly patients with severe sepsis that develop organ failure. Our aim was to evaluate the impact of the source of infection on mortality for elderly patients with severe sepsis.
We conducted a retrospective national cohort study including patients > 65 years hospitalized in Department of Veterans Affairs medical centers with a discharge diagnosis of sepsis in fiscal years 2002–2007 and that received antibiotics within 48 hours of admission. We defined sepsis by using prior validated lCD-9 codes, and evaluated 30-day mortality.
We identified 11,618 cases of severe sepsis over the 6-year period. The frequency of sources of infection was: respiratory (37%), genitourinary (26%), abdominal (9%), skin and soft tissue (7%), neurological (< 1%) and other (20%). Mortality at 30 days was 44.6% for respiratory infections, 40.9% for abdominal infections, 37.7% for CNS infections, and 34.7% for both genitourinary and skin and soft tissue infections. Mortality from an unidentified source of infection was significantly higher (54.3% vs. 41.8%, P < 0.001) than from a documented source.
Although elderly patients with severe sepsis have a high mortality, patients with unidentified sources of infections have an even higher mortality at 30 days when compared with patients with identified source of infection. Among the group of patients with identified source, respiratory infections have the highest mortality.
Additional research focusing on identifying the sources of sepsis is needed as patients with an unidentified source have increased mortality.
Maria Velez, No Financial Disclosure Information; No Product/Research Disclosure Information