Open Access Highly Accessed Research article

Bloodstream infections and sepsis in Greece: over-time change of epidemiology and impact of de-escalation on final outcome

Marina Koupetori1, Theodoros Retsas2, Nikolaos Antonakos3, Glykeria Vlachogiannis4, Ioannis Perdios5, Christos Nathanail6, Konstantinos Makaritsis7, Antonios Papadopoulos3, Dimitrios Sinapidis2, Evangelos J Giamarellos-Bourboulis3*, Ioannis Pneumatikos8, Charalambos Gogos9, Apostolos Armaganidis10, Elisabeth Paramythiotou10 and on behalf of the Hellenic Sepsis Study Group

Author Affiliations

1 1st Department of Internal Medicine, Thriassio General Hospital, Elefsis, Greece

2 Department of Therapeutics, University of Athens, Medical School, Athens, Greece

3 4th Department of Internal Medicine, University of Athens, Medical School, 1 Rimini Street, 12462 Athens, Greece

4 Intensive Care Unit, Aghios Dimitrios General Hospital, Thessaloniki, Greece

5 Intensive Care Unit, Artas General Hospital, Artas, Greece

6 Department of Internal Medicine, General Hospital of the University of Thessaly, Larissa, Greece

7 1st Department of Internal Medicine, G.Gennimatas General Hospital, Athens, Greece

8 Intensive Care Unit, Democriteion University Hospital, Alexandroupolis, Greece

9 Department of Internal Medicine, University of Patras, Rion, Greece

10 2nd Department of Critical Care Medicine, University of Athens, Medical School, Athens, Greece

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BMC Infectious Diseases 2014, 14:272  doi:10.1186/1471-2334-14-272

Published: 18 May 2014



Choice of empirically prescribed antimicrobials for sepsis management depends on epidemiological factors. The epidemiology of sepsis in Greece was studied in two large-periods.


Sepsis due to bloodstream infections (BSI) from July 2006 until March 2013 was recorded in a multicenter study in 46 departments. Patients were divided into sepsis admitted in the emergencies and hospitalized in the general ward (GW) and sepsis developing after admission in the Intensive Care Unit (ICU). The primary endpoints were the changes of epidemiology and the factors related with BSIs by multidrug-resistant (MDR) pathogens; the secondary endpoint was the impact of de-escalation on antimicrobial therapy.


754 patients were studied; 378 from 2006–2009 and 376 from 2010–2013. Major differences were recorded between periods in the GW. They involved increase of: sepsis severity; the incidence of underlying diseases; the incidence of polymicrobial infections; the emergence of Klebsiella pneumoniae as a pathogen; and mortality. Factors independently related with BSI by MDR pathogens were chronic hemofiltration, intake of antibiotics the last three months and residence into long-term care facilities. De-escalation in BSIs by fully susceptible Gram-negatives did not affect final outcome. Similar epidemiological differences were not found in the ICU; MDR Gram-negatives predominated in both periods.


The epidemiology of sepsis in Greece differs in the GW and in the ICU. De-escalation in the GW is a safe strategy.

Bloodstream infections; Sepsis; De-escalation; Resistance