- Poster presentation
- Open Access
Clinical characteristics, management, and outcomes of sepsis in Lusaka, Zambia
- Published: 27 October 2011
Keywords
- Severe Sepsis
- Adjusted Odds Ratio
- Organ Dysfunction
- Septic Patient
- Streptococcus Pneumoniae
Introduction
Although infectious diseases are the leading causes of death in sub-Saharan Africa, there are few studies describing sepsis in the region. Available data suggest that HIV prevalence is disproportionately high among septic patients and that treatment, particularly fluid administration, may be suboptimal [1]. Our study evaluated the clinical characteristics, management, and hospital outcomes of patients admitted with sepsis in Zambia. We hypothesized that patients with bacteremia have higher in-hospital mortality than those without.
Methods
We conducted a prospective observational study of patients admitted with sepsis to the Adult Filter Clinic (medical ER) of the University Teaching Hospital (UTH) in Lusaka Zambia. Sepsis was defined as two or more SIRS criteria and clinically suspected infection. Baseline characteristics and laboratory results were recorded, as was the timing of antibiotics and fluid administration. Patients were followed until discharge or death.
Results
Risk factors for in-hospital death
Variable | Adjusted OR | Crude OR |
---|---|---|
Anemia, Hb <9 g/dl | 0.91 (0.74 to 4.93) | 1.05 (0.56 to 1.80) |
Blood culture positive | 4.8 (1.50 to 15.0) | 2.38 (1.14 to 4.95) |
GCS | ||
≥13 | 1 | 1 |
9 to 12 | 5.50 (1.90 to 16.20) | 3.60 (1.60 to 8.11) |
<9 | 16.00 (2.90 to 87.10) | 11.2 (3.50 to 36.4) |
HIV | ||
Negative | 1 | 1 |
Positive | 4.20 (1.00 to 17.00) | 2.35 (0.88 to 6.28) |
Unknown | 7.70 (1.20 to 47.70) | 8.38 (2.36 to 29.7) |
<1 hour to IVF | 0.40 (0.10 to 1.10) | 0.86 (0.43 to 1.72) |
MAP <65 | 2.10 (0.70 to 6.80) | 1.25 (0.56 to 2.81) |
IVF in first 6 hours | ||
0 | 1 | 1 |
1 | 0.80 (0.30 to 2.00) | 0.81 (0.41 to 1.61) |
2 or more | 0.30 (0.10 to 1.10) | 0.60 0.23 to 1.58) |
Conclusion
In-hospital mortality due to sepsis is higher in Zambia than in most studies from the developed world. Low Glasgow Coma Scale and positive blood cultures are associated with increased in-hospital mortality. Insufficient i.v. fluid administration probably contributes to the high overall mortality. Standardized management including early fluids and antibiotics might improve outcomes of sepsis and severe sepsis in sub-Saharan Africa.
Authors’ Affiliations
References
- Jacob S, et al: Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One. 2009, 4: e7782-10.1371/journal.pone.0007782.PubMed CentralView ArticlePubMedGoogle Scholar
Copyright
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.