Incidence of septicemia increasing among service members, study finds

The annual incidence rates of primary diagnosed septicemia among active component service members increased nearly 580 percent from 2004 to 2012, according to a new study.

During the 13-year surveillance period 3,360 hospitalized active component service members were identified as incident cases of septicemia based on diagnoses recorded in any diagnostic position, according to the study published in the Medical Surveillance Monthly Report, a peer-reviewed journal on illnesses and diseases affecting service members from the Armed Forces Health Surveillance Center.

Septicemia is an acute illness that occurs when pathogenic organisms invade the bloodstream and cause systemic inflammation. Individuals diagnosed with septicemia are usually hospitalized because the infection must be treated with aggressive drug therapy (e.g., antibiotics) in order to prevent progression into systematic inflammatory response syndrome and sepsis.

Septicemia may complicate conditions that are relatively frequently associated with military service; such conditions include combat7,8 and non-combat trauma (e.g., fractures, amputations, penetrating wounds, burns) and bacterial infections (e.g., pneumonia, urinary tract infections [UTIs], cellulitis/abscesses)

From 2000 to 2012, 1,033 service members were diagnosed with septicemia in the secondary diagnostic position. Incidence rates of secondary diagnosed septicemia increased 345 percent from 2000 to 2011, and then decreased 24 percent from 2011 to 2012.

Of hospitalizations for which septicemia was reported in the primary or secondary positions, the overall incidence rate was higher among females than males (Incidence rate ratio [IRR]: 1.4). The annual rates were similar among females and males from 2000 to 2005; however, after 2005 the rates in females increased 430 percent and the rates in males increased 227
percent.

Of 1,033 hospitalization records with septicemia-specific diagnoses in secondary diagnostic positions, the most frequent primary diagnoses were complications of surgical/medical care (18.3 percent), pneumonias (17.8 percent), skin/subcutaneous tissue infections (9.2 percent), and injuries (e.g., fractures, burns, amputations)

From 2000 to 2012, the number of bed days during septicemia-related (i.e., primary/secondary diagnosis) hospitalizations increased by 421 percent, and the number of individuals affected increased by 449 percent. The average number of bed days per affected individual overall was nine days; however, annual averages ranged from 7 (in 2012) to 12 (in 2006) days per affected individual.

Of service members with known dispositions after hospitalizations with septicemia, most (88.3%) returned to duty, 6.8 percent were transferred or discharged to another medical facility, 3.3 percent died, and 1.6 percent had "other" dispositions (e.g., discharged home, separated from service).

During the 18-month period from January 2012 to June 2013, 540, 914 tests for antibodies to HIV were performed on 519,723 civilian applicants for U.S. military service, according to the study published in the Medical Surveillance Monthly Report, a peer-reviewed journal from the Armed Forces Health Surveillance Center. Of those tested during this period, 101 were found to have antibodies to HIV (seroprevalence: 0.19 per 1,000 persons tested). From 2008 to 2012, annual rates declined 53 percent from 0.49 per 1,000 persons tested in 2008 to 0.23 per 1,000 persons tested in 2012.

This report documents that infectious diseases (i.e., pneumonias, skin infections, UTIs) and sequelae of other conditions (i.e., complications of surgical/medical care, injuries, childbirth) that are relatively common among military members were the most frequently reported co-occurring diagnoses with septicemia. The finding suggests that earlier detection and more effective treatment of such relatively common conditions among military members may decrease the incidence of septicemia among them.