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Does Infection Site Matter? A Systematic Review of Infection Site Mortality in Sepsis FREE TO VIEW

Christine Motzkus-Feagans, MPH; Stephen Heard, MD; Roger Luckmann, MD
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University of Massachusetts Medical School, Worcester, MA

Chest. 2015;148(4_MeetingAbstracts):344A. doi:10.1378/chest.2273100
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Current sepsis treatment protocols emphasize source control with empiric antibiotics in conjunction with fluid resuscitation. Previous reviews have examined the impact of the specific locus of infection on mortality from sepsis along with specific pathogens; however, no recent review has addressed this issue. This review focuses on studies that address the role of infection site on hospital mortality among patients with sepsis.

METHODS: The PubMed database was queried for the study period from January 2001 to September 2014. Studies were eligible if they were published in English and they included: 1) one or more regression models with hospital mortality as the outcome and considered infection site for inclusion in the model, and 2) adult patients with sepsis, severe sepsis or septic shock. Data elements abstracted included number of patients, sepsis spectrum level, infection sites measured, and raw and adjusted effect estimates for the association between infection site and hospital mortality. Raw effect estimates were calculated for studies that did not provide raw estimates of association.

RESULTS: 19 studies were included for review. Most studies measured infection sites including respiratory (n=19), abdominal (n=19), genitourinary (n=18), and skin and soft tissue infections (n=11). Overall, few studies found statistically significant unadjusted risk for mortality due to respiratory infection compared to other sites. Several studies found statistically significant protective effects of genitourinary infections on hospital mortality when compared to respiratory infections.

CONCLUSIONS: Most included studies focused on severe sepsis or septic shock. Hospital mortality does not appear to differ by site of infection with the exception of a possible protective benefit of genitourinary infections among these included studies. Further research needs to be conducted in populations that are less severely ill, including those at the stage of sepsis before conclusions can be made.

CLINICAL IMPLICATIONS: The role of infection site in sepsis remains controversial. The site of infection does not appear to affect sepsis mortality with the exception of a trend towards reduced mortality in septic patients with urinary tract infections.

DISCLOSURE: The following authors have nothing to disclose: Christine Motzkus-Feagans, Stephen Heard, Roger Luckmann

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