epidemiologyЭпидемиология и ВакцинопрофилактикаEpidemiology and Vaccinal Prevention2073-30462619-0494«Numicom» LLC10.31631/2073-3046-2021-20-3-107-117epidemiology-1295Research ArticleОБЗОРREVIEWСепсис в XXI веке: этиология, факторы риска, эпидемиологические особенности, осложнения, профилактикаSepsis in the XXI Century: Etiology, Risk Factors, Epidemiological Features, Complications, Preventionhttps://orcid.org/0000-0002-6713-7090ГомановаЛ. И.GomanovaL. I.

Лилия Ильинична Гоманова  – студентка Института Общественного Здоровья им. Ф. Ф. Эрисмана (Сеченовский Университет) 

г. Москва

Liliya I. Gomanova  – student of Institute of Public Health (Sechenov University)

Moscow

gomanova_liliya@mail.ruhttps://orcid.org/0000-0002-5587-8860БражниковА. Ю.BrazhnikovA. Y.

Бражников Алексей Юрьевич  – к. м. н., доцент кафедры эпидемиологии и  доказательной медицины Института Общественного Здоровья им. Ф. Ф. Эрисмана (Сеченовский Университет) 

г. Москва

Alexey Y. Brazhnikov – Cand. Sci. (Med.), Associate Professor at the Department of Epidemiology and evidence-based medicine of Institute of Public Health (Sechenov University) 

Moscow

brazhnikov_a_yu@staff.sechenov.ruФГАОУ ВО Первый МГМУ им. И. М. Сеченова Минздрава России (Сеченовский Университет)РоссияSechenov UniversityRussian Federation202120072021203107117Copyright © Гоманова Л.И., Бражников А.Ю., 20212021Гоманова Л.И., Бражников А.Ю.Gomanova L.I., Brazhnikov A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epidemvac.ru/jour/article/view/1295Актуальность

Актуальность. Третьим Международным Консенсусом (Sepsis-3) было принято современное определение сепсиса: «Сепсис – это жизнеугрожающая дисфункция органов, являющаяся следствием дисрегулированного ответа человека на инфекцию». По оценкам, ежегодное число случаев сепсиса во всем мире может достигать 48 млн. Увеличение доли внутрибольничных инфекций, рост сопутствующей патологии, быстрое развитие осложнений приводит к негативной динамике в возникновении случаев сепсиса и смерти от него.

Цель

Цель. Обзор эпидемиологических характеристик сепсиса в мире и РФ, изучение этиологии, факторов риска, осложнений и профилактики сепсиса.

Выводы

Выводы. Сепсис остается нерешенной проблемой здравоохранения многих стран мира. По оценкам экспертов, ежегодная заболеваемость сепсисом (Классы МКБ-10: A00-B99, A30-A49, A41) в соответствии с критериями «Sepsis-3» составляет 838 на 100 тыс. Анализируя заболеваемость сепсисом и смертность от него, можно выявить негативную динамику последних лет, которая характерна для США, большинства стран Европы и Азии. Заболеваемость всеми формами сепсиса варьирует от 25 на 100 тыс. в Италии (2006) до 883 на 100 тыс. в Швеции (2019). Каждый четвертый случай сепсиса (24,4%) в мире возникает во время пребывания в ОРИТ. Госпитальная летальность от всех форм сепсиса в различных странах составляет от 17,5% в Испании (2013) до 46,3% в целом и 64,5% при госпитализации в ОРИТ в Бразилии (2006–2015). В РФ отсутствуют крупные исследования, направленные на оценку заболеваемости сепсисом и смертности от него. По результатам исследований, проведенных на базе ОРИТ стационаров Санкт-Петербурга, частота встречаемости сепсиса составляла 35 на 100 больных ОРИТ в 2006–2007 гг. и 15 – в 2015 г. При изучении эпидемиологических особенностей сепсиса можно выявить изменение критериев диагностики сепсиса; сложности в сопоставлении данных о сепсисе, тяжелом сепсисе и септическом шоке, а также в оценке данных о внебольничном и внутрибольничном сепсисе. Профилактика сепсиса играет важную роль. Среди основных профилактических стратегий по снижению заболеваемости сепсисом можно выделить повышение осведомленности о сепсисе; определение лиц, находящихся в группах риска развития сепсиса; своевременную диагностику сепсиса; лечение сопутствующей патологии, приводящей к потенциальному развитию сепсиса и прогрессированию его осложнений. Эпидемиологическая ситуация по сепсису продолжает ухудшаться в связи с ростом антибиотикорезистентных штаммов бактерий, увеличением доли фунгальных агентов, несвоевременно начатой антибактериальной терапией, неблагоприятным коморбидным фоном пациента и другими факторами. Для повышения качества жизни пациентов большое значение имеют ранняя диагностика и своевременное лечение сепсиса. Лечение хронических инфекционных заболеваний, сведение к минимуму управляемых факторов риска, разработка популяционных скрининговых программ позволят в дальнейшем снизить уровень заболеваемости сепсисом и смертности от него.

Relevance

Relevance. Sepsis is a life-threatening organ dysfunction caused by dysregulation of the body's response to infection. It is estimated that the annual number of sepsis cases worldwide could be 48 million. An increase in the role of nosocomial infections, an increase in concomitant pathology, and the rapid development of complications lead to negative dynamics in the sepsis incidence and mortality.

Aims

Aims. Review of the epidemiological characteristics of sepsis in the world and the Russian Federation, study of the etiology, risk factors, complications and prevention of sepsis.

Conclusions

Conclusions. The data obtained indicate that sepsis remains an unsolved public health problem in many countries of the world. According to modern data, the annual sepsis (ICD-10: A00-B99, A30-A49, A41) incidence among the adult population in accordance with «Sepsis-3» is 838 per 100 ths. So, assessing the incidence of sepsis and mortality from it, we can identify the negative dynamics of recent years, which is typical for the United States of America, Europe and Asia. For example, the incidence of all forms of sepsis ranges from 25 per 100 ths in Italy (2006) to 883 per 100 ths in Sweden (2019). Moreover, every fourth case of sepsis (24.4%) in the world was acquired during a stay in an ICU. Hospital mortality from all forms of sepsis in various countries ranged from 17.5% in Spain (2013) to 46.3% as a whole and 64.5% with admission to ICU in Brazil (2006–2015). Unfortunately, in the Russian Federation, there are no large studies aimed at assessing sepsis incidence and mortality. According to the results of studies conducted on the basis of ICU in hospitals of St. Petersburg, sepsis incidence was 35 per 100 ICU patients (2006–2007) and 15 per 100 ICU patients (2015). When studying the epidemiological features of sepsis, the following difficulties can be identified: changing the criteria for diagnosing sepsis, comparing data on sepsis, severe sepsis and septic shock, evaluating data on community-acquired and in-hospital sepsis. So, sepsis prevention plays an important role in the public health of many countries. Major preventive strategies to reduce sepsis incidence include raising awareness of sepsis; identification of persons at risk; early diagnosis of sepsis; treatment of comorbid pathology leading to the potential development of sepsis and progression of its complications. The epidemiological status continues to deteriorate due to the growth of antibioticresistant strains, an increase in the proportion of fungal agents, late antibiotic therapy, an unfavorable comorbid status and other factors. Early diagnosis and timely clinical management of sepsis play the main role in the improvement in the quality of life. For example, treatment of chronic infectious diseases, minimization of manageable risk factors, and development of population screening programs will further reduce sepsis incidence and mortality.

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The authors declare that there are no conflicts of interest present.