• Naomi E Hammond, Ashwani Kumar, Parmeet Kaur, Bharath Kumar Tirupakuzhi Vijayaraghavan, Arpita Ghosh, Sarah Grattan, Vivekanand Jha, Dilip Mathai, Balasubramanian Venkatesh, and Sepsis in India Prevalence Study (SIPS) Investigator Network.
• Critical Care Program, The George Institute for Global Health and the University of New South Wales, Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia. Electronic address: nhammond@georgeinstitute.org.au.
• Chest. 2022 Jun 1; 161 (6): 1543-1554.

BackgroundSepsis is a global health problem. Limited data exist on the prevalence of sepsis using current definitions in ICUs in India.Research QuestionIn adult patients admitted to ICUs in India, what is the prevalence of sepsis using the previous (Second International Consensus Definitions for Sepsis and Septic Shock [Sepsis-2]) and current (Third International Consensus Definitions for Sepsis and Septic Shock [Sepsis-3]) definitions?Study Design And MethodsProspective, observational, multicentre, 1-day, cross-sectional study. The primary outcome was the sepsis prevalence using both the Sepsis-2 and Sepsis-3 definitions and their concordance (using Cohen's κ coefficient). Additional outcomes included reporting on current microbiological characteristics, antimicrobial use, multidrug-resistant infections, and 30-day discharge and mortality status in patients with sepsis.ResultsA total of 35 ICUs (85.7% private, 14.3% public) participated, enrolling 680 patients (median age, 60 years [interquartile range, 24 years]; 62.1% men). The most common primary diagnosis was renal disease, and common comorbidities were diabetes (44.0%) and chronic renal failure (11.6%). The sepsis prevalence on the study day was 382 of 677 patients (56.4%). Prevalence by Sepsis-3 and Sepsis-2 definitions was 33.2% and 46.2%, respectively, with minimal concordance (κ = 0.32). In patients with sepsis, the most common microorganisms were bacterial (77.9%) followed by fungal (14.1%) infections. Approximately 45% of infections were caused by multidrug-resistant organisms. Mortality at 30 days after the study day (27.6% vs 5.3%; P < .01) and rates of discharge against medical advice (12.8% vs 4.9%; P < .01) were significantly higher in the sepsis cohort compared with the cohort without sepsis, respectively.InterpretationThis multicenter point prevalence study in Indian ICUs showed a high burden of sepsis using both Sepsis-2 and Sepsis-3 criteria, with associated high rates of antimicrobial resistance and mortality. These findings have implications for public health and future research.Copyright © 2022 American College of Chest Physicians. All rights reserved.

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