Severe Sepsis in Two Ugandan Hospitals: a Prospective Observational Study of Management and Outcomes in a Predominantly HIV-1 Infected Population
Shevin T. Jacob,Christopher C. Moore,Patrick Banura,Relana Pinkerton,David B. Meya,Pius Opendi,Steven J. Reynolds,Steven J. Reynolds,Nathan Kenya-Mugisha,Harriet Mayanja-Kizza,W. Michael Scheld +10 more
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TLDR
Patients presenting with sepsis syndromes to two Ugandan hospitals had late stage HIV infection and high mortality, and clinical predictors of in-hospital mortality were easily measurable and can be used for triaging patients in resource-constrained settings.Abstract:
Background Sepsis likely contributes to the high burden of infectious disease morbidity and mortality in low income countries. Data regarding sepsis management in sub-Saharan Africa are limited. We conducted a prospective observational study reporting the management and outcomes of severely septic patients in two Ugandan hospitals. We describe their epidemiology, management, and clinical correlates for mortality. Methodology/Results Three-hundred eighty-two patients fulfilled enrollment criteria for a severe sepsis syndrome. Vital signs, management and laboratory results were recorded. Outcomes measured included in-hospital and post-discharge mortality. Most patients were HIV-infected (320/377, 84.9%) with a median CD4+ T cell (CD4) count of 52 cells/mm3 (IQR, 16–131 cells/mm3). Overall mortality was 43.0%, with 23.7% in-hospital mortality (90/380) and 22.3% post-discharge mortality (55/247). Significant predictors of in-hospital mortality included admission Glasgow Coma Scale and Karnofsky Performance Scale (KPS), tachypnea, leukocytosis and thrombocytopenia. Discharge KPS and early fluid resuscitation were significant predictors of post-discharge mortality. Among HIV-infected patients, CD4 count was a significant predictor of post-discharge mortality. Median volume of fluid resuscitation within the first 6 hours of presentation was 500 mLs (IQR 250–1000 mls). Fifty-two different empiric antibacterial regimens were used during the study. Bacteremic patients were more likely to die in hospital than non-bacteremic patients (OR 1.83, 95% CI = 1.01–3.33). Patients with Mycobacterium tuberculosis (MTB) bacteremia (25/249) had higher in-hospital mortality (OR 1.97, 95% CI = 1.19–327) and lower median CD4 counts (p = 0.001) than patients without MTB bacteremia. Conclusion Patients presenting with sepsis syndromes to two Ugandan hospitals had late stage HIV infection and high mortality. Bacteremia, especially from MTB, was associated with increased in-hospital mortality. Most clinical predictors of in-hospital mortality were easily measurable and can be used for triaging patients in resource-constrained settings. Procurement of low cost and high impact treatments like intravenous fluids and empiric antibiotics may help decrease sepsis-associated mortality in resource-constrained settings.read more
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References
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Journal ArticleDOI
Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis
Roger C. Bone,Robert A. Balk,F. B. Cerra,R. P. Dellinger,A. M. Fein,William A. Knaus,Roland M. H. Schein,W. J. Sibbald +7 more
TL;DR: An American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae as mentioned in this paper.
Journal ArticleDOI
Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
Emanuel P. Rivers,Bryant Nguyen,Suzanne Havstad,Julie Ressler,Alexandria Muzzin,Bernhard P. Knoblich,Edward L. Peterson,Michael C. Tomlanovich +7 more
TL;DR: This study randomly assigned patients who arrived at an urban emergency department with severe sepsis or septic shock to receive either six hours of early goal-directed therapy or standard therapy (as a control) before admission to the intensive care unit.
Journal ArticleDOI
Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.
Derek C. Angus,Walter T. Linde-Zwirble,Jeffrey Lidicker,Gilles Clermont,Joseph A. Carcillo,Michael R. Pinsky +5 more
TL;DR: Severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction, and is especially common in the elderly and is likely to increase substantially as the U.S. population ages.
Journal ArticleDOI
The Epidemiology of Sepsis in the United States from 1979 through 2000
TL;DR: The rate of sepsis due to fungal organisms increased by 207 percent, with gram-positive bacteria becoming the predominant pathogens after 1987, and the total in-hospital mortality rate fell, yet the total number of deaths continued to increase.
Journal ArticleDOI
Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock.
Anand Kumar,Daniel Roberts,Kenneth E. Wood,Bruce Light,Joseph E. Parrillo,Satendra Sharma,Robert Suppes,Daniel Feinstein,Sergio Zanotti,Leo Taiberg,David A. Gurka,Aseem Kumar,Mary Cheang +12 more
TL;DR: Effective antimicrobial administration within the first hour of documented hypotension was associated with increased survival to hospital discharge in adult patients with septic shock.
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