Sepsis is a global health problem with high morbidity and mortality. Low- and middle-income countries have a higher incidence and poorer outcome with sepsis. Large epidemiological studies in sepsis using Sepsis-3 criteria, addressing the process of care and deriving predictors of mortality are scarce in India. A multicentre, prospective sepsis registry was conducted using Sepsis 3 criteria of suspected or confirmed infection and SOFA score of 2 or more in 19 ICUs in India over a period of one year (August 2022–July 2023). All adult patients admitted to the Intensive Care Unit who fulfilled the Sepsis 3 criteria for sepsis and septic shock were included. Patient infected with Covid 19 were excluded. Patients demographics, severity, admission details, initial resuscitation, laboratory and microbiological data and clinical outcome were recorded. Performance improvement programs as recommended by the Surviving Sepsis guideline were noted from the participating centers. Patients were followed till discharge or death while in hospital. Registry Data of 1172 patients with sepsis (including 500 patients with septic shock) were analysed. The average age of the study cohort was 65 years, and 61% were male. The average APACHE II and SOFA score was 21 and 6.7 respectively. The majority of patients had community-acquired infections, and lung infections were the most common source. Of all culture positive results, 65% were gram negative organism. Carbapenem-resistance was identified in 50% of the gram negative blood culture isolates. The predominant gram negative organisms were Klebsiella spp (25%), Escherechia coli (24%) and Acinetobacter Spp (11%). Tropical infections (Dengue, Malaria, Typhus) constituted minority (n = 32, 2.2%) of sepsis patients. The observed hospital mortality for the entire cohort (n = 1172) was 36.3%, for those without shock (n = 672) it was 25.6% and for those with shock (n = 500) it was 50.8%. The average length of ICU and hospital stay for the study cohort was 8.64 and 11.9 respectively. In multivariate analysis adequate source control, correct choice of empiric antibiotic and the use of intravenous thiamine were protective. The general demographics of the sepsis population in the Indian Sepsis Registry is comparable to Western population. The mortality of sepsis cohort was higher (36.3%) but septic shock mortality (50.8%) was comparable to Western reports. Gram negative infection was the predominant cause of sepsis with a high incidence of carbapenem resistance. Eschericia coli, Klebsiella Spp and Acinetobacter Spp were the predominant causative organism. Tropical infection constituted a minority of sepsis population with low hospital mortality. The SOFA score on admission was a comparatively better predictor of poor outcome. Sepsis secondary to nosocomial infections had the worst outcomes, while source control, correct empirical antibiotic selection, and intravenous thiamine were protective. CTRI Registration CTRI:2022/07/044516.

中文翻译：

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印度 ICU 收治的 1000 名脓毒症患者的多中心前瞻性登记：（SEPSIS INDIA） 研究


脓毒症是一个全球性的健康问题，发病率和死亡率都很高。低收入和中等收入国家的脓毒症发病率较高，结局较差。在印度，使用脓毒症 3 标准对脓毒症进行的大型流行病学研究很少，这些研究涉及护理过程并得出死亡率的预测因子。在一年内（2022 年 8 月至 2023 年 7 月），在印度的 19 个 ICU 中使用疑似或确诊感染的脓毒症 3 标准和 SOFA 评分为 2 分或以上，进行了多中心前瞻性脓毒症登记。包括所有符合脓毒症和感染性休克脓毒症 3 标准的重症监护病房成年患者。感染 Covid 19 的患者被排除在外。记录患者人口统计学、严重程度、入院详情、初始复苏、实验室和微生物学数据以及临床结局。参与中心记录了 Surviving Sepsis 指南推荐的绩效改进计划。对患者进行随访直至出院或住院死亡。分析了 1172 例脓毒症患者 （包括 500 例脓毒性休克患者） 的登记数据。研究队列的平均年龄为 65 岁，其中 61% 为男性。平均 APACHE II 和 SOFA 评分分别为 21 分和 6.7 分。大多数患者为社区获得性感染，肺部感染是最常见的来源。在所有培养阳性结果中，65% 为革兰氏阴性菌。在 50% 的革兰氏阴性血培养分离株中鉴定出碳青霉烯类耐药性。主要的革兰氏阴性菌是克雷伯菌属 （25%） 、大肠埃希里氏菌 （24%） 和不动杆菌属 （11%）。热带感染（登革热、疟疾、斑疹伤寒）占败血症患者的少数 （n = 32， 2.2%）。 整个队列 （n = 1172） 观察到的住院死亡率为 36.3%，无休克患者 （n = 672） 为 25.6%，休克患者 （n = 500） 为 50.8%。研究队列的平均 ICU 和住院时间分别为 8.64 和 11.9。在多变量分析中，充分的来源控制、正确选择经验性抗生素和静脉注射硫胺素具有保护作用。印度脓毒症登记处脓毒症人群的一般人口统计数据与西方人群相当。脓毒症队列的死亡率较高 （36.3%），但感染性休克死亡率 （50.8%） 与西方报告相当。革兰阴性菌感染是脓毒症的主要原因，碳青霉烯类耐药发生率高。大肠埃希菌 （Eschericia coli） 、 克雷伯菌属 （Klebsiella Spp） 和不动杆菌属 （Acinetobacter Spp） 是主要的致病微生物。热带感染在脓毒症人群中占少数，住院死亡率低。入院时 SOFA 评分是相对较好的不良结局预测指标。继发于医院感染的脓毒症结局最差，而来源控制、正确的经验性抗生素选择和静脉注射硫胺素具有保护作用。CTRI 注册 CTRI：2022/07/044516.