Yutaka Umemura1, Hiroshi Ogura2, Kiyotsugu Takuma3, Seitato Fujishima4, Toshikazu Abe5, Shigeki Kushimoto6, Toru Hifumi7, Akiyoshi Hagiwara8, Atsushi Shiraishi9, Yasuhiro Otomo10, Daizoh Saitoh11, Toshihiko Mayumi12, Kazuma Yamakawa13, Yasukazu Shiino14, Taka-Aki Nakada15, Takehiko Tarui16, Kohji Okamoto17, Joji Kotani18, Yuichiro Sakamoto19, Junichi Sasaki20, Shin-Ichiro Shiraishi21, Ryosuke Tsuruta22, Tomohiko Masuno23, Naoshi Takeyama24, Norio Yamashita25, Hiroto Ikeda26, Masashi Ueyama27, Satoshi Gando28. 1. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan; Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: plum00022@gmail.com. 2. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: ogura@hp-emerg.med.osaka-u.ac.jp. 3. Emergency and Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan. Electronic address: drtakumaphd@fa2.so-net.ne.jp. 4. Center for General Medicine Education, Keio University School of Medicine, Shinjuku City, Tokyo, Japan. Electronic address: fujishim@z6.keio.jp. 5. Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: abetoshi111@gmail.com. 6. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: kussie@emergency-medicine.med.tohoku.ac.jp. 7. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Chuo City, Tokyo, Japan. Electronic address: hifumitoru@gmail.com. 8. Center Hospital of the National Center for Global Health and Medicine, Shinjuku City, Tokyo, Japan. Electronic address: akiyoshi.hagiwara3266@gmail.com. 9. Emergency and Trauma Center, Kameda Medical Center, Kamogawa, Chiba, Japan. Electronic address: siris.accm@tmd.ac.jp. 10. Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: otomo.accm@tmd.ac.jp. 11. Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Saitama, Japan. Electronic address: ds0711@ndmc.ac.jp. 12. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan. Electronic address: mtoshi@med.nagoya-u.ac.jp. 13. Department of Emergency Medicine, Osaka Medical College, Osaka, Japan. Electronic address: kyamakawa-osk@umin.ac.jp. 14. Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan. Electronic address: shiino@me.com. 15. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: taka.nakada@nifty.com. 16. Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. Electronic address: tarui@ks.kyorin-u.ac.jp. 17. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Fukuoka, Japan. Electronic address: kohji.okamot@gmail.com. 18. Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: kotanijo0412@gmail.com. 19. Emergency and Critical Care Medicine, Saga University Hospital, Nabeshima, Saga, Japan. Electronic address: sakamoy@cc.saga-u.ac.jp. 20. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku City, Tokyo, Japan. Electronic address: sasakij@1989.jukuin.keio.ac.jp. 21. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Fukushima, Japan. Electronic address: shinshi@nms.ac.jp. 22. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan. Electronic address: tsurutar@yamaguchi-u.ac.jp. 23. Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo City, Tokyo, Japan. Electronic address: masuno@nms.ac.jp. 24. Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Aichi, Japan. Electronic address: takeyama@aichi-med-u.ac.jp. 25. Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Fukuoka, Japan. Electronic address: norio22@med.kurume-u.ac.jp. 26. Department of Emergency Medicine, Teikyo University School of Medicine, Itabashi, Tokyo, Japan. Electronic address: ikeda@med.teikyo-u.ac.jp. 27. Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Aichi, Japan; Community Healthcare Organization, Chukyo Hospital, Nagoya, Aichi, Japan. Electronic address: m.ueyama@gmail.com. 28. Department of Anesthesiology and Critical Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan; Department of Acute and Critical Care Medicine, Sapporo Tokushukai Hospital, Higashi, Sapporo, Hokkaido, Japan. Electronic address: gandoicoud@icloud.com.
Abstract
BACKGROUND: There is no one-size-fits-all empiric antimicrobial therapy for sepsis because the pathogens vary according to the site of infection and have changed over time. Therefore, updating knowledge on the spectrum of pathogens is necessary for the rapid administration of appropriate antimicrobials. OBJECTIVE: The aim of this study was to elucidate the current spectrum of pathogens and its variation by site of infection in sepsis. METHODS: This was a prospective nationwide cohort study of consecutive adult patients with sepsis in 59 intensive care units in Japan. The spectrum of pathogens was evaluated in all patients and in subgroups by site of infection. Regression analyses were conducted to evaluate the associations between the pathogens and mortality. RESULTS: The study cohort comprised 1184 patients. The most common pathogen was Escherichia coli (21.5%), followed by Klebsiella pneumoniae (9.0%). However, the pattern varied widely by site of infection; for example, gram-positive bacteria were the dominant pathogen in bone/soft tissue infection (55.7%) and cardiovascular infection (52.6%), but were rarely identified in urinary tract infection (6.4%). In contrast, gram-negative bacteria were the predominant pathogens in abdominal infection (38.4%) and urinary tract infection (72.0%). The highest mortality of 47.5% was observed in patients infected with methicillin-resistant Staphylococcus aureus, which was significantly associated with an increased risk of death (odds ratio 1.88, 95% confidence interval 1.22-2.91). CONCLUSIONS: This study revealed the current spectrum of pathogens and its variation based on the site of infection, which is essential for empiric antimicrobial therapy against sepsis.
BACKGROUND: There is no one-size-fits-all empiric antimicrobial therapy for sepsis because the pathogens vary according to the site of infection and have changed over time. Therefore, updating knowledge on the spectrum of pathogens is necessary for the rapid administration of appropriate antimicrobials. OBJECTIVE: The aim of this study was to elucidate the current spectrum of pathogens and its variation by site of infection in sepsis. METHODS: This was a prospective nationwide cohort study of consecutive adult patients with sepsis in 59 intensive care units in Japan. The spectrum of pathogens was evaluated in all patients and in subgroups by site of infection. Regression analyses were conducted to evaluate the associations between the pathogens and mortality. RESULTS: The study cohort comprised 1184 patients. The most common pathogen was Escherichia coli (21.5%), followed by Klebsiella pneumoniae (9.0%). However, the pattern varied widely by site of infection; for example, gram-positive bacteria were the dominant pathogen in bone/soft tissue infection (55.7%) and cardiovascular infection (52.6%), but were rarely identified in urinary tract infection (6.4%). In contrast, gram-negative bacteria were the predominant pathogens in abdominal infection (38.4%) and urinary tract infection (72.0%). The highest mortality of 47.5% was observed in patientsinfected with methicillin-resistant Staphylococcus aureus, which was significantly associated with an increased risk of death (odds ratio 1.88, 95% confidence interval 1.22-2.91). CONCLUSIONS: This study revealed the current spectrum of pathogens and its variation based on the site of infection, which is essential for empiric antimicrobial therapy against sepsis.