Skip to main content
SpringerLink
Log in

Epidemiology of Sepsis: Current Data and Predictions for the Future

  • Chapter
  • First Online:
Sepsis

Part of the book series: Respiratory Medicine ((RM))

  • 5275 Accesses

Abstract

Descriptions of sepsis can be found in humanity’s oldest written documents. It has long been recognized as a cause of severe illness and death. In the modern era, advances in the microbiology brought with them the understanding of sepsis as a severe inflammatory response to infection. Consensus conferences have provided definitions of sepsis that emphasize its many potential manifestations and allow us to study its incidence over time and space. Studies of the epidemiology of sepsis demonstrate significant variability in both design and outcome measurements, but several points remain relatively consistent. Severe sepsis and septic shock are both common problems in intensive care units (ICUs) worldwide and incidence appears to be increasing. Mortality rates are significant but appear to be improving over time. The disease is quite costly, accounting for major portions of both ICU and overall healthcare expenditure. Sepsis appears to disproportionately affect men, blacks, and patients of lower socioeconomic status in most studies and has been shown to have a genetic component as well. It is strongly associated with malignancy, HIV, obesity, and diabetes mellitus. The most common site of infection driving sepsis has been and continues to be the lungs, while the predominant etiologic agent seems to be shifting from gram-negative organisms to gram-positive organisms over time.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA. 1995;273(2):117–23.

    Article  CAS  PubMed  Google Scholar 

  2. Sands KE, Bates DW, Lanken PN, Graman PS, Hibberd PL, Kahn KL, et al. Epidemiology of sepsis syndrome in 8 academic medical centers. JAMA. 1997;278(3):234–40.

    Article  CAS  PubMed  Google Scholar 

  3. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.

    Article  CAS  PubMed  Google Scholar 

  4. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.

    Article  CAS  PubMed  Google Scholar 

  5. Whittaker SA, Fuchs BD, Gaieski DF, Christie JD, Goyal M, Meyer NJ, et al. Epidemiology and outcomes in patients with severe sepsis admitted to the hospital wards. J Crit Care. 2014;30(1):78–84. Epub 2014 Jul 22

    Article  PubMed  Google Scholar 

  6. Rohde JM, Odden AJ, Bonham C, Kuhn L, Malani PN, Chen LM, et al. The epidemiology of acute organ system dysfunction from severe sepsis outside of the intensive care unit. J Hosp Med. 2013;8(5):243–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–54.

    Article  PubMed  Google Scholar 

  8. Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, et al. Nationwide trends of severe sepsis in the 21st century (2000–2007). Chest. 2011;140(5):1223–31.

    Article  PubMed  Google Scholar 

  9. Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis. Crit Care Med. 2014;42(3):625–31.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41(5):1167–74.

    Article  PubMed  Google Scholar 

  11. Wang HE, Devereaux RS, Yealy DM, Safford MM, Howard G. National variation in United States sepsis mortality: a descriptive study. Int J Health Geogr. 2010;9:9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35(5):1244–50.

    Article  PubMed  Google Scholar 

  13. Iwashyna TJ, Odden A, Rohde J, Bonham C, Kuhn L, Malani P, et al. Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis. Med Care. 2014;52(6):e39–43.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Barochia AV, Cui X, Vitberg D, Suffredini AF, O’Grady NP, Banks SM, et al. Bundled care for septic shock: an analysis of clinical trials. Crit Care Med. 2010;38(2):668–78.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Miller 3rd RR, Dong L, Nelson NC, Brown SM, Kuttler KG, Probst DR, et al. Multicenter implementation of a severe sepsis and septic shock treatment bundle. Am J Respir Crit Care Med. 2013;188(1):77–82.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gaieski DF, Edwards JM, Kallan MJ, Mikkelsen ME, Goyal M, Carr BG. The relationship between hospital volume and mortality in severe sepsis. Am J Respir Crit Care Med. 2014;190(6):665–74.

    Article  PubMed  Google Scholar 

  17. Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312(1):90–2.

    Article  CAS  PubMed  Google Scholar 

  18. Harrison DA, Welch CA, Eddleston JM. The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care. 2006;10(2):R42.

    Article  PubMed  PubMed Central  Google Scholar 

  19. van Gestel A, Bakker J, Veraart CP, van Hout BA. Prevalence and incidence of severe sepsis in Dutch intensive care units. Crit Care. 2004;8(4):R153–62.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med. 2004;30(4):589–96.

    Article  PubMed  Google Scholar 

  21. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311(13):1308–16.

    Article  CAS  PubMed  Google Scholar 

  22. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA. 1995;274(12):968–74.

    Article  CAS  PubMed  Google Scholar 

  23. Brun-Buisson C, Meshaka P, Pinton P, Vallet B. EPISEPSIS: a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 2004;30(4):580–8.

    Article  CAS  PubMed  Google Scholar 

  24. Edwards R, Hutson R, Johnson J, Sherwin R, Gordon-Strachan G, Frankson M, et al. Severe sepsis in the emergency department—an observational cohort study from the university hospital of the West Indies. West Indian Med J. 2013;62(3):224–9.

    CAS  PubMed  Google Scholar 

  25. Esteban A, Frutos-Vivar F, Ferguson ND, Penuelas O, Lorente JA, Gordo F, et al. Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med. 2007;35(5):1284–9.

    Article  PubMed  Google Scholar 

  26. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010;376(9749):1339–46.

    Article  PubMed  Google Scholar 

  27. Linde-Zwirble WT, Angus DC. Severe sepsis epidemiology: sampling, selection, and society. Crit Care. 2004;8(4):222–6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Angus DC, Sirio CA, Clermont G, Bion J. International comparisons of critical care outcome and resource consumption. Crit Care Clin. 1997;13(2):389–407.

    Article  CAS  PubMed  Google Scholar 

  29. Wier LM, Pfuntner A, Maeda J, Stranges E, Ryan K, Jagadish P, et al. HCUP facts and figures: statistics on hospital-based care in the United States, 2009. Rockville, MD: Agency for Healthcare Research and Quality; 2011.

    Google Scholar 

  30. Brun-Buisson C, Roudot-Thoraval F, Girou E, Grenier-Sennelier C, Durand-Zaleski I. The costs of septic syndromes in the intensive care unit and influence of hospital-acquired sepsis. Intensive Care Med. 2003;29(9):1464–71.

    Article  PubMed  Google Scholar 

  31. Edbrooke DL, Hibbert CL, Kingsley JM, Smith S, Bright NM, Quinn JM. The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit. Crit Care Med. 1999;27(9):1760–7.

    Article  CAS  PubMed  Google Scholar 

  32. Moerer O, Plock E, Mgbor U, Schmid A, Schneider H, Wischnewsky MB, et al. A German national prevalence study on the cost of intensive care: an evaluation from 51 intensive care units. Crit Care. 2007;11(3):R69.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Vaughan-Sarrazin MS, Bayman L, Cullen JJ. Costs of postoperative sepsis: the business case for quality improvement to reduce postoperative sepsis in veterans affairs hospitals. Arch Surg. 2011;146(8):944–51.

    Article  PubMed  Google Scholar 

  34. Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE. Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med. 2010;38(5):1276–83.

    Article  PubMed  Google Scholar 

  35. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304(16):1787–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM. Population burden of long-term survivorship after severe sepsis in older Americans. J Am Geriatr Soc. 2012;60(6):1070–7.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Storgaard M, Hallas J, Gahrn-Hansen B, Pedersen SS, Pedersen C, Lassen AT. Short- and long-term mortality in patients with community-acquired severe sepsis and septic shock. Scand J Infect Dis. 2013;45(8):577–83.

    Article  PubMed  Google Scholar 

  38. Prescott HC, Langa KM, Liu V, Escobar GJ, Iwashyna TJ. Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med. 2014;190(1):62–9.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Liu V, Lei X, Prescott HC, Kipnis P, Iwashyna TJ, Escobar GJ. Hospital readmission and healthcare utilization following sepsis in community settings. J Hosp Med. 2014;9(8):502–7.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15–21.

    Article  PubMed  Google Scholar 

  41. Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K. Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med. 2003;31(9):2332–8.

    Article  PubMed  Google Scholar 

  42. Sakr Y, Elia C, Mascia L, Barberis B, Cardellino S, Livigni S, et al. The influence of gender on the epidemiology of and outcome from severe sepsis. Crit Care. 2013;17(2):R50.

    Article  PubMed  PubMed Central  Google Scholar 

  43. van Eijk LT, Dorresteijn MJ, Smits P, van der Hoeven JG, Netea MG, Pickkers P. Gender differences in the innate immune response and vascular reactivity following the administration of endotoxin to human volunteers. Crit Care Med. 2007;35(6):1464–9.

    Article  PubMed  Google Scholar 

  44. Valentin A, Jordan B, Lang T, Hiesmayr M, Metnitz PG. Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med. 2003;31(7):1901–7.

    Article  PubMed  Google Scholar 

  45. Mayr FB, Yende S, Linde-Zwirble WT, Peck-Palmer OM, Barnato AE, Weissfeld LA, et al. Infection rate and acute organ dysfunction risk as explanations for racial differences in severe sepsis. JAMA. 2010;303(24):2495–503.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Barnato AE, Alexander SL, Linde-Zwirble WT, Angus DC. Racial variation in the incidence, care, and outcomes of severe sepsis: analysis of population, patient, and hospital characteristics. Am J Respir Crit Care Med. 2008;177(3):279–84.

    Article  PubMed  Google Scholar 

  47. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Occurrence and outcomes of sepsis: influence of race. Crit Care Med. 2007;35(3):763–8.

    Article  PubMed  Google Scholar 

  48. Mayr FB, Yende S, D’Angelo G, Barnato AE, Kellum JA, Weissfeld L, et al. Do hospitals provide lower quality of care to black patients for pneumonia? Crit Care Med. 2010;38(3):759–65.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Mendu ML, Zager S, Moromizato T, McKane CK, Gibbons FK, Christopher KB. The association between primary language spoken and all-cause mortality in critically ill patients. J Crit Care. 2013;28(6):928–34.

    Article  PubMed  Google Scholar 

  50. Fowler RA, Noyahr LA, Thornton JD, Pinto R, Kahn JM, Adhikari NK, et al. An official American Thoracic Society systematic review: the association between health insurance status and access, care delivery, and outcomes for patients who are critically ill. Am J Respir Crit Care Med. 2010;181(9):1003–11.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Koch K, Norgaard M, Schonheyder HC, Thomsen RW, Sogaard M. Effect of socioeconomic status on mortality after bacteremia in working-age patients. A Danish population-based cohort study. PLoS One. 2013;8(7):e70082.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Mendu ML, Zager S, Gibbons FK, Christopher KB. Relationship between neighborhood poverty rate and bloodstream infections in the critically ill. Crit Care Med. 2012;40(5):1427–36.

    Article  PubMed  Google Scholar 

  53. Sorensen TI, Nielsen GG, Andersen PK, Teasdale TW. Genetic and environmental influences on premature death in adult adoptees. N Engl J Med. 1988;318(12):727–32.

    Article  CAS  PubMed  Google Scholar 

  54. Henckaerts L, Nielsen KR, Steffensen R, Van Steen K, Mathieu C, Giulietti A, et al. Polymorphisms in innate immunity genes predispose to bacteremia and death in the medical intensive care unit. Crit Care Med. 2009;37(1):192–201. e1–3

    Article  CAS  PubMed  Google Scholar 

  55. Sutherland AM, Walley KR, Russell JA. Polymorphisms in CD14, mannose-binding lectin, and Toll-like receptor-2 are associated with increased prevalence of infection in critically ill adults. Crit Care Med. 2005;33(3):638–44.

    Article  CAS  PubMed  Google Scholar 

  56. Khor CC, Chapman SJ, Vannberg FO, Dunne A, Murphy C, Ling EY, et al. A Mal functional variant is associated with protection against invasive pneumococcal disease, bacteremia, malaria and tuberculosis. Nat Genet. 2007;39(4):523–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Agnese DM, Calvano JE, Hahm SJ, Coyle SM, Corbett SA, Calvano SE, et al. Human toll-like receptor 4 mutations but not CD14 polymorphisms are associated with an increased risk of gram-negative infections. J Infect Dis. 2002;186(10):1522–5.

    Article  CAS  PubMed  Google Scholar 

  58. Waterer GW, Bruns AH. Genetic risk of acute pulmonary infections and sepsis. Expert Rev Respir Med. 2010;4(2):229–38.

    Article  CAS  PubMed  Google Scholar 

  59. Williams MD, Braun LA, Cooper LM, Johnston J, Weiss RV, Qualy RL, et al. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care. 2004;8(5):R291–8.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129(6):1432–40.

    Article  PubMed  Google Scholar 

  61. Greenberg JA, Lennox JL, Martin GS. Outcomes for critically ill patients with HIV and severe sepsis in the era of highly active antiretroviral therapy. J Crit Care. 2012;27(1):51–7.

    Article  PubMed  Google Scholar 

  62. Coquet I, Pavie J, Palmer P, Barbier F, Legriel S, Mayaux J, et al. Survival trends in critically ill HIV-infected patients in the highly active antiretroviral therapy era. Crit Care. 2010;14(3):R107.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Japiassu AM, Amancio RT, Mesquita EC, Medeiros DM, Bernal HB, Nunes EP, et al. Sepsis is a major determinant of outcome in critically ill HIV/AIDS patients. Crit Care. 2010;14(4):R152.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 May 28;384(9945):766–81.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Yaegashi M, Jean R, Zuriqat M, Noack S, Homel P. Outcome of morbid obesity in the intensive care unit. J Intensive Care Med. 2005;20(3):147–54.

    Article  PubMed  Google Scholar 

  66. Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I, Fleury JC. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med. 2004;32(4):998–1003.

    Article  PubMed  Google Scholar 

  67. Wang HE, Griffin R, Judd S, Shapiro NI, Safford MM. Obesity and risk of sepsis: a population-based cohort study. Obesity (Silver Spring). 2013;21(12):E762–9.

    Article  CAS  Google Scholar 

  68. Arabi YM, Dara SI, Tamim HM, Rishu AH, Bouchama A, Khedr MK, et al. Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Crit Care. 2013;17(2):R72.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Prescott HC, Chang VW, O’Brien Jr JM, Langa KM, Iwashyna T. Obesity and 1-year outcomes in older Americans with severe sepsis. Crit Care Med. 2014 Apr 8;42(8):1766–74.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005;41(3):281–8.

    Article  CAS  PubMed  Google Scholar 

  71. Stegenga ME, Vincent JL, Vail GM, Xie J, Haney DJ, Williams MD, et al. Diabetes does not alter mortality or hemostatic and inflammatory responses in patients with severe sepsis. Crit Care Med. 2010;38(2):539–45.

    Article  PubMed  Google Scholar 

  72. Kornum JB, Thomsen RW, Riis A, Lervang HH, Schonheyder HC, Sorensen HT. Type 2 diabetes and pneumonia outcomes: a population-based cohort study. Diabetes Care. 2007;30(9):2251–7.

    Article  PubMed  Google Scholar 

  73. Ani C, Farshidpanah S, Bellinghausen Stewart A, Nguyen HB. Variations in organism-specific severe sepsis mortality in the United States: 1999–2008. Crit Care Med. 2014 Sep 16;43(1):65–77.

    Article  Google Scholar 

  74. Leligdowicz A, Dodek PM, Norena M, Wong H, Kumar A. Association between source of infection and hospital mortality in patients who have septic shock. Am J Respir Crit Care Med. 2014;189(10):1204–13.

    Article  PubMed  Google Scholar 

  75. Cohen J, Cristofaro P, Carlet J, Opal S. New method of classifying infections in critically ill patients. Crit Care Med. 2004;32(7):1510–26.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, 615 Michael Street, Suite 205, Atlanta, GA, 30322, USA

    Bashar Staitieh MD & Greg S. Martin MD, MSc

Authors
  1. Bashar Staitieh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Greg S. Martin MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Greg S. Martin MD, MSc .

Editor information

Editors and Affiliations

  1. Division of Pulmonary Critical Care, and Sleep Medicine, Alpert/Brown Medical School, Providence, Rhode Island, USA

    Nicholas S. Ward

  2. Division of Pulmonary Critical Care, and Sleep Medicine, Alpert/Brown Medical School, Providence, Rhode Island, USA

    Mitchell M. Levy

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Staitieh, B., Martin, G.S. (2017). Epidemiology of Sepsis: Current Data and Predictions for the Future. In: Ward, N., Levy, M. (eds) Sepsis. Respiratory Medicine. Humana Press, Cham. https://doi.org/10.1007/978-3-319-48470-9_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-48470-9_3

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-48468-6

  • Online ISBN: 978-3-319-48470-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation