Clinical Report: Trends in Sepsis Epidemiology in Spain (2017-2022)

Overview

This nationwide retrospective study examined sepsis epidemiology in Spain from 2017 through 2022 using the Spanish Minimum Basic Data Set. Among 1,187,393 sepsis hospitalizations, annual cases increased from 183,971 in 2017 to 226,884 in 2022. Age-adjusted incidence reached 4.65 per 1,000 inhabitants in 2022, while in-hospital mortality peaked at 23.7% in 2020 and declined to 20.8% in 2022. A separate analysis excluding COVID-19-associated hospitalizations showed more stable underlying trends, although indirect pandemic effects could not be eliminated.

Background

Sepsis remains a major global health challenge associated with high incidence, mortality, and healthcare costs. Previous population-based studies in Spain using the Minimum Basic Data Set ended their analyses in 2013 or 2017. Since then, changes including adoption of Sepsis-3 definitions, transition to ICD-10-CM coding, population aging, increasing comorbidity burden, and the COVID-19 pandemic have altered the context in which sepsis epidemiology is assessed. The current study was designed to provide an updated national evaluation of sepsis incidence, in-hospital mortality, clinical characteristics, infection sources, and healthcare burden.

Data Highlights

The study included 1,187,393 hospitalizations with sepsis from January 1, 2017, through December 31, 2022. Annual sepsis cases increased from 183,971 in 2017 to 226,884 in 2022. Patients had a mean age of 74.3 years, and 54.7% were male. Respiratory infections accounted for 40.7% of infection sources and genitourinary infections for 40.4%. Overall in-hospital mortality was 20.8%.

Key Findings

• Age-adjusted sepsis incidence reached 4.65 per 1,000 inhabitants in 2022 after a pandemic-era rebound.

• In-hospital mortality was 19.4% in 2017, peaked at 23.7% in 2020, and declined to 20.8% in 2022. Mortality in the non-COVID-19 sepsis cohort remained relatively stable.

• Patients were predominantly older adults with substantial comorbidity burden. Endocrine and metabolic disorders affected 64.3% of patients, respiratory diseases 34.6%, hypertension 33.5%, and diabetes 30.6%.

• Respiratory and genitourinary infections were the leading sources of sepsis, accounting for 40.7% and 40.4% of cases, respectively.

• The number of organ failures, Charlson Comorbidity Index, intensive care unit admission, and invasive mechanical ventilation were independently associated with increased in-hospital mortality.

• Total national expenditure increased from €6.6 billion in 2017 to €9.6 billion in 2021 before declining to €7.9 billion in 2022.

• Documented bacterial resistance increased from 3.39% of sepsis episodes in 2017 to 5.11% in 2022, while documented beta-lactam resistance increased from 2.07% to 3.55%.

Clinical Implications

The findings indicate that sepsis continues to place a substantial burden on the Spanish National Health System, particularly among older patients with multiple comorbidities. The authors highlight the importance of identifying high-risk patients, supporting prevention and early detection strategies, allocating adequate healthcare resources, and tailoring clinical management to an increasingly older and medically complex patient population. Trends should be interpreted in the context of both population aging and the direct and indirect effects of the COVID-19 pandemic.

Conclusion

Sepsis epidemiology in Spain remained strongly influenced by the COVID-19 pandemic during the study period. Overall age-adjusted incidence rebounded to 4.65 per 1,000 inhabitants in 2022, while hospital mortality stabilized at 20.8%. Non-COVID-19 sepsis incidence also showed a more moderate increase. The findings underscore the persistent burden of sepsis and the need for adequate resource allocation and optimal clinical management for an increasingly complex patient population.

Related Resources & Content

Epidemiological trends in sepsis in Spain: incidence, in-hospital mortality, and healthcare burden (2017-2022) — Rocío López Herrero, Paula Martínez-Jiménez, Daniel Ortiz del Olmo, Rosa Dolores Prieto-Utrera, Rosa Cobo-Zubia, Adrián García-Concejo, Mario Lorenzo-López, Irina Rebollo-Mato, Fernando Vaquerizo-Villar, Rodrigo Poves-Álvarez, Esther Gómez-Sánchez, and Eduardo Tamayo — International Journal of Infectious Diseases — Publication year: 2026; accepted September 14, 2026.

Global, regional, and national sepsis incidence and mortality, 1990-2021: a systematic analysis — Gray AP, Chung E, Hsu RL, Araki DT, Hayoon AG, Weaver ND, et al. — The Lancet Global Health — 2025.

Epidemiology, management and costs of sepsis in Spain (2008-2017): a retrospective multicentre study — Darbà J, Marsà A — Current Medical Research and Opinion — 2020.

Epidemiological trends of sepsis in the twenty-first century (2000-2013): an analysis of incidence, mortality, and associated costs in Spain — Álvaro-Meca A, Jiménez-Sousa MA, Micheloud D, Sánchez-López A, Heredia-Rodríguez M, Tamayo E, et al. — Population Health Metrics — 2018.

Surviving sepsis campaign research priorities 2023 — De Backer D, Deutschman C, Hellman J, Myatra S, Ostermann M, Prescott H, et al. — Critical Care Medicine — 2024.

Declining mortality due to severe sepsis and septic shock in Spanish intensive care units: a two-cohort study in 2005 and 2011 — Sánchez B, Ferrer R, Suarez D, Romay E, Piacentini E, Gomà G, et al. — Medicina Intensiva — 2017.

Hospital-related costs of sepsis around the world: a systematic review exploring the economic burden of sepsis — van den Berg M, van Beuningen FE, ter Maaten JC, Bouma HR — Journal of Critical Care — 2022.