Intensive Care Med (2016) 42:1980–1989
Incidence of severe sepsis and septic
shock in German intensive care units: the
prospective, multicentre INSEP study
SepNet Critical Care Trials Group
© 2016 Springer-Verlag Berlin Heidelberg and ESICM
Purpose: To estimate the incidence density, point prevalence and outcome of severe sepsis and septic shock in Ger-
man intensive care units (ICUs).
Methods: In a prospective, multicentre, longitudinal observational study, all patients already on the ICU at 0:00 on 4
November 2013 and all patients admitted to a participating ICU between 0:00 on 4 November 2013 and 2359 hours
on 1 December 2013 were included. The patients were followed up for the occurrence of severe sepsis or septic shock
(SEPSIS-1 deﬁnitions) during their ICU stay.
Results: A total of 11,883 patients from 133 ICUs at 95 German hospitals were included in the study, of whom 1503
(12.6 %) were diagnosed with severe sepsis or septic shock. In 860 cases (57.2 %) the infections were of nosocomial
origin. The point prevalence was 17.9 % (95 % CI 16.3–19.7).The calculated incidence rate of severe sepsis or septic
shock was 11.64 (95 % CI 10.51–12.86) per 1000 ICU days. ICU mortality in patients with severe sepsis/septic shock
was 34.3 %, compared with 6 % in those without sepsis. Total hospital mortality of patients with severe sepsis or septic
shock was 40.4 %. Classiﬁcation of the septic shock patients using the new SEPSIS-3 deﬁnitions showed higher ICU
and hospital mortality (44.3 and 50.9 %).
Conclusions: Severe sepsis and septic shock continue to be a frequent syndrome associated with high hospital mor-
tality. Nosocomial infections play a major role in the development of sepsis. This study presents a pragmatic, aﬀord-
able and feasible method for the surveillance of sepsis epidemiology. Implementation of the new SEPSIS-3 deﬁnitions
may have a major eﬀect on future epidemiological data.
Keywords: Sepsis, Septic shock, Incidence, Incidence density, Prevalence
Sepsis is a frequent syndrome associated with high mor-
bidity, mortality  and long-term disability . Valid
epidemiological data on sepsis are important to moni
tor the burden for the healthcare system and to allocate
ﬁnances to patient care and research. A systematic review
of studies addressing sepsis epidemiology worldwide
revealed a highly variable incidence of 13–300 per 100,000
inhabitants per year for severe sepsis and 11 per 100,000
inhabitants per year for septic shock . ese data are in
line with several European studies reporting an incidence
of 66–114 per 100,000 inhabitants per year [4–6].
It was reported that the incidence of sepsis has
increased during recent decades because of factors such
as advancing age, immunosuppression and multidrug-
resistant infections [7, 8]. e change over time in sepsis
epidemiology has mainly been studied in the USA and
Australia/New Zealand but not in European countries
Department of Intensive Care Medicine, University Hospital RWTH
Aachen, c/o G. Marx, Pauwelsstr. 30, 52074 Aachen, Germany
A full list of SepNet Critical Care Trials Group (SepNet) authors and
investigators is presented in the supplementary material (ESM2).