Clinical and microbiological characterization of sepsis and evaluation of sepsis scores

Abstract

Background Despite the necessity of early recognition for an optimal outcome, sepsis often remains unrecognized. Available tools for early recognition are rarely evaluated in low- and middle-income countries. In this study, we analyzed the spectrum, treatment and outcome of sepsis at an Ethiopian tertiary hospital and evaluated recommended sepsis scores. Methods Patients with an infection and ≥2 SIRS criteria were screened for sepsis by SOFA scoring. From septic patients, socioeconomic and clinical data as well as blood cultures were collected and they were followed until discharge or death; 28-day mortality was determined. Results In 170 patients with sepsis, the overall mortality rate was 29.4%. The recognition rate by treating physicians after initial clinical assessment was low (12.4%). Increased risk of mortality was significantly associated with level of SOFA and qSOFA score, Gram-negative bacteremia (in comparison to Gram-positive bacteremia; 42.9 versus 16.7%), and antimicrobial regimen including ceftriaxone (35.7% versus 19.2%) or metronidazole (43.8% versus 25.0%), but not with an increased respiratory rate (≥22/min) or decreased systolic blood pressure (≤100mmHg). In Gram-negative isolates, extended antimicrobial resistance with expression of extended-spectrum beta-lactamase and carbapenemase genes was common. Among adult patients, sensitivity and specificity of qSOFA score for detection of sepsis were 54.3% and 66.7%, respectively. Conclusion Sepsis is commonly unrecognized and associated with high mortality, showing the need for reliable and easy-applicable tools to support early recognition. The established sepsis scores were either of limited applicability (SOFA) or, as in the case of qSOFA, were significantly impaired in their sensitivity and specificity, demonstrating the need for further evaluation and adaptation to local settings. Regional factors like malaria endemicity and HIV prevalence might influence the performance of different scores. Ineffective empirical treatment due to antimicrobial resistance is common and associated with mortality. Local antimicrobial resistance statistics are needed for guidance of calculated antimicrobial therapy to support reduction of sepsis mortality.

Reduction of BSI associated mortality after a sepsis project implementation in the ER of a tertiary referral hospital

“…Although this result is in line with other studies 13 , some scepticism was also observed 14 , 15 . As a result, the real advantages of sepsis bundles have been questioned, and uncertain data are currently available.…”

“…The main feature of our study has been the inclusion of those patients with positive BC, rather than all those with a clinical suspicion of sepsis, as the sepsis clinical presentation might frequently resemble that of other morbid conditions 16 . Although we agree with Fuchs et al’s findings that a standardised method of BCs may positively contribute to optimised management of sepsis, and consequently to an improved survival rate of septic patients 14 , it should be mentioned that BCs collection procedures have been already standardised during period A in our ER. This virtuous practice, which had already been introduced in the period A, and consistently maintained throughout the period B, allowed to attain a positive BCs rate around 30%.…”

Reduction of BSI associated mortality after a Sepsis Project implementation in the ER of a tertiary referral Hospital

“…Although this result is in line with other studies[16], some skepticism was also observed [17,18]. As a result, the real advantages of sepsis bundles have been questioned, and uncertain data are currently available.…”

“…Hence, the septic clinical presentation might frequently resemble that of other morbid conidtions [19]. Firstly, although we agree with Fuchs et al's ndings that a standardized method of BCs may positively contribute to optimized management of sepsis, and consequently to an improved survival rate of septic patients [17], it should be mentioned that BCs collection procedures have been already standardized during period A in our ER. This virtuous practice, which had already been introduced in the period A, and consistently maintained throughout the period B, allowed to attain a positive BCs rate around 30%.…”

High Rate of Multidrug-resistance Among Clinical Isolates of Gram-negative Bacteria in Hospitalized Patients With Febrile Diseases in Central Ethiopia

“…Continued extensive empiric use of 3GC in the absence of AST might lead to a further decrease in antimicrobial activity and therefore increase the burden on resource-limited health care systems of the countries affected (8). This development can also be observed locally and previous investigations at the study site show that the effectiveness of the limited choice of available antimicrobials is diminished due to the high rate of ESBL-producing GNB (9). There is an increasing need for strategies to enhance prudent use of antibiotics in the country due to the alarming spread of ESBL-producing GNB leading to high rates of infections due to MDR, which are di cult if not impossible to treat (10,11).…”