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Overview :
Farinas-Alvarez evaluated risk factors associated with
nosocomial sepsis in surgical patients. These can help identify patients who may
require more aggressive management and closer monitoring. The authors are from
the University of Cantabria and University Hospital "Marques de Valdecilla" in
Santander, Spain.
Exclusion criteria:
(1) age < 15 years of age
(2) severe granulocytopenia (< 500 neutrophils per µL)
(3) HIV infection
(4) organ transplant
(5) transfers from other hospitals
Risk factors existing on admission:
(1) severity of illness (using the MaCabe-Jackson criteria as
described in Chapter 23)
(2) coma
(3) serum albumin
(4) development of complications before sepsis (not
defined)
(5) number
of intrinsic comorbid conditions (not defined but presumable coronary artery
disease or heart failure, COPD, diabetes, renal failure, peripheral vascular
disease, stroke, etc.)
Risk factors associated with health care:
(1) care in the ICU
(2) parenteral nutrition
(3) nasogastric tube
(4)
extrinsic risk factors (intravenous catheter, urinary catheter, mechanical
ventilation, parenteral nutrition, "etc.")
Risk factors associated with surgery:
(1) urgency of surgery
(2) surgical site
(3) number of surgical interventions
(4) SENIC index
(5) NNIS index
|
Parameter |
Finding |
Weight |
|
severity of illness |
non-fatal |
0 |
|
|
ultimately fatal |
1 |
|
|
rapidly fatal |
2 |
|
coma within 48 hours of sepsis onset |
absent |
0 |
|
|
present |
2 |
|
serum albumin |
>= 4.0 g/dL |
0 |
|
|
3.6 - 3.9 g/dL |
2 |
|
|
<= 3.5 g/dL |
2 |
|
complications before sepsis |
absent |
0 |
|
|
present |
1 |
|
intrinsic comorbid conditions |
none |
0 |
|
|
1 or 2 |
1 |
|
|
>= 3 |
2 |
|
care in hospital |
non-ICU |
0 |
|
|
in ICU |
1 |
|
parenteral nutrition |
none |
0 |
|
|
present |
2 |
|
nasogastric tube |
absent |
0 |
|
|
present |
1 |
|
extrinsic risk factors |
<= 6 |
0 |
|
|
> 6 |
1 |
|
urgency of surgery |
emergency |
1 |
|
|
non-emergency |
0 |
|
surgical site |
abdominal |
1 |
|
|
non-abdominal |
0 |
|
surgical interventions |
1 |
0 |
|
|
>=2 |
1 |
|
SENIC index |
0 or 1 |
0 |
|
|
2 |
1 |
|
|
3 or 4 |
2 |
|
NNIS index |
0 |
0 |
|
|
1 or 2 |
1 |
|
|
3 |
2 |
where:
• Odds
ratios from 1.01 to 1.5 were considered not significant.
• Odds
ratios from 1.6 to 4.9 were weighted as 1.
• Odds
ratios >= 5 were weighted as 2 (one option is to weight 5-10 as 2 and > 10
as 3).
Antibiotic prophylaxis may reduce the risk.
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