Association Between the Site of Infection and Mortality Analysis in Critically Ill Surgical Patients

Waleed Bin Ghaffar; Sidra Nazir; Summiya Siddiqui; Moeed B Abdul Ghaffar; Muhammad F Khan; Asad Latif; Zahra Cheema; Sadaf Hanif; Mohammad Sohaib

doi:10.7759/cureus.50033

Association Between the Site of Infection and Mortality Analysis in Critically Ill Surgical Patients

Cureus. 2023 Dec 6;15(12):e50033. doi: 10.7759/cureus.50033. eCollection 2023 Dec.

Authors

Waleed Bin Ghaffar¹, Sidra Nazir¹, Summiya Siddiqui¹, Moeed B Abdul Ghaffar², Muhammad F Khan¹, Asad Latif¹, Zahra Cheema¹, Sadaf Hanif³, Mohammad Sohaib¹

Affiliations

¹ Anaesthesiology, Aga Khan University Hospital, Karachi, PAK.
² Surgery, Aga Khan University Hospital, Karachi, PAK.
³ Medicine, Aga Khan University Hospital, Karachi, PAK.

Abstract

Background Sepsis remains a critical global health concern, leading to a high mortality rate. Existing literature suggests a potential correlation between infection site and mortality. Mortality data from Pakistan, especially in the context of the infection site, is notably scarce. Purpose The study aimed to explore the relationship between the site of infection and clinical features in deceased septic patients in the surgical intensive care unit. Methods In this retrospective study conducted at the Aga Khan University Hospital, data from patients admitted to the surgical intensive care unit and meeting Sepsis 3 criteria over a five-year period (2016-2020) were analyzed. We analyzed the relation between the infection site and clinical characteristics using analysis of variance (ANOVA), chi-square, or Fisher's exact tests. Multivariable logistic regression models were applied using stepwise forward selection. A p-value of ≤ 0.05 was considered statistically significant. Results A total of 2472 ICU admissions were screened, out of which 170 patients were included in this study. Demographic analysis showed a predominantly male population with a mean age of 47 years. The most prevalent site of infection was the abdomen. Logistic regression analysis identified on-admission septic shock and high Acute Physiology and Chronic Health Evaluation (APACHE) II scores as significant risk factors for 48-hour mortality while colistimethate sodium usage and admission through the operating room were protective. Conclusion Our study provides a comprehensive analysis, outlining infection sites and identifying early mortality-influencing factors within our region. The distinct demographic profile, characterized by younger age, and the prevalence of abdominal infections in the Pakistani cohort contradict established medical literature. Early initiation of broad-spectrum antibiotics, coupled with prompt source control, confers a protective effect upon individuals afflicted with sepsis.

Keywords: developing countries; infections; intensive care units; intraabdominal infections; mortality; sepsis; septic shock; surgical wound infection.