Recommendations for infection management in patients with sepsis and septic shock in resource-limited settings

Thwaites, C. Louise; Lundeg, Ganbold; Dondorp, Arjen M.

doi:10.1007/s00134-016-4415-3

Cited by 23 publications

(12 citation statements)

References 12 publications

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“…Children with sepsis were reported to receive the 1st dose of antibiotics within the 1st hour of presentation to the hospital in this survey. This practice is in agreement with the guidelines from resource-rich countries, which recommends antibiotics administration within the first hour of recognizing sepsis or septic shock in resource limited settings (5). In our setting, the choice of antibiotics was a challenge due to lack of epidemiological data, poor microbiological laboratory capacity and reduced availability of antibiotics.…”

Section: Discussionsupporting

confidence: 64%

A National Survey of Resources to Address Sepsis in Children in Tertiary Care Centers in Nigeria

et al. 2019

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Background: Infections leading to sepsis are major contributors to mortality and morbidity in children world-wide. Determining the capacity of pediatric hospitals in Nigeria to manage sepsis establishes an important baseline for quality-improvement interventions and resource allocations. Objectives: To assess the availability and functionality of resources and manpower for early detection and prompt management of sepsis in children at tertiary pediatric centers in Nigeria. Methods: This was an online survey of tertiary pediatric hospitals in Nigeria using a modified survey tool designed by the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS). The survey addressed all aspects of pediatric sepsis identification, management, barriers and readiness. Results: While majority of the hospitals 97% (28/29) reported having adequate triage systems, only 60% (16/27) follow some form of guideline for sepsis management. There was no consensus national guideline for management of pediatric sepsis. Over 50% of the respondents identified deficit in parental education, poor access to healthcare services, failure to diagnose sepsis at referring institutions, lack of medical equipment and lack of a definitive protocol for managing pediatric sepsis, as significant barriers. Conclusions: Certain sepsis-related interventions were reportedly widespread, however, there is no standardized sepsis protocol, and majority of the hospitals do not have pediatric intensive care units (PICU). These findings could guide quality improvement measures at institutional level, and healthcare policy/spending at the national level.

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Section: Discussionsupporting

confidence: 64%

A National Survey of Resources to Address Sepsis in Children in Tertiary Care Centers in Nigeria

et al. 2019

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“…The leading organism was Escherichia coli , which was similar to previous reports from our hospital. 20 , 21 However, in resource-limited settings, the expert consensus recommendation 22 and the latest SSC 23 suggest that in sepsis a combination of antibiotics should be used, especially in septic shock patients. The results of our study complement this recommendation as nearly 70% of septic shock patients admitted in the MICU had health care-associated infection, and empirical antibiotic monotherapy was associated with 28-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Timing of antibiotic administration and lactate measurement in septic shock patients: a comparison between hospital wards and the emergency department

Vattanavanit¹,

Buppodom²,

Khwannimit³

2018

IDR

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BackgroundThe timing of intravenous antibiotic administration and lactate measurement is associated with survival of septic shock patients. Septic shock patients were admitted to the medical intensive care unit (MICU) from 2 major sources: hospital ward and emergency department (ED). This study aimed to compare the timing of antibiotic administration and lactate measurement between hospital wards and the ED.Patients and methodsMedical data were collected from adult patients admitted to the MICU with septic shock from January 2015 to December 2016. “Time Zero” was defined as the time of diagnosis of sepsis. The associations between the times and risk-adjusted 28-day mortality were assessed.ResultsIn total, 150 septic shock patients were admitted to the MICU. The median time interval (hour [h] interquartile range [IQR]) from time zero to antibiotic administration was higher in patients from the hospital wards compared to those from the ED (4.84 [3.5–8.11] vs 2.04 [1.37–3.54], P<0.01), but the lactate level measurement time interval (h [IQR]) from time zero was not different between the hospital wards and the ED (1.6 [0.2–2.7] vs 1.6 [0.9–3.0], P=0.85). In multivariate analysis, higher risk-adjusted 28-day mortality was associated with antibiotic monotherapy (odds ratio [OR]: 19.3, 95% confidence interval [CI]: 2.4–153.1, P<0.01) and admission during the weekends (OR: 24.4, 95% CI: 2.9–199.8, P<0.01).ConclusionAntibiotic administration in septic shock patients from the hospital wards took longer, and there was also less appropriate antibiotic prescriptions seen in this group compared with those admitted from the ED. However, neither the timing of antibiotic administration nor lactate measurement was associated with mortality.

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“…Several groups have published guidelines for the management of sepsis in low-resource settings [ 82 , 83 ]. Although laudable and an important step forward, these guidelines are largely nonevidence-based for low-resource environments and reflect care in high-resource settings, which may not be available or appropriate.…”

Section: Practical Steps To Reduce the Global Burden Of Sepsismentioning

confidence: 99%

The global burden of sepsis: barriers and potential solutions

et al. 2018

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Sepsis is a major contributor to the global burden of disease. The majority of sepsis cases and deaths are estimated to occur in low and middle-income countries. Barriers to reducing the global burden of sepsis include difficulty quantifying attributable morbidity and mortality, low awareness, poverty and health inequity, and under-resourced and low-resilience public health and acute health care delivery systems. Important differences in the populations at risk, infecting pathogens, and clinical capacity to manage sepsis in high and low-resource settings necessitate context-specific approaches to this significant problem. We review these challenges and propose strategies to overcome them. These strategies include strengthening health systems, accurately identifying and quantifying sepsis cases, conducting inclusive research, establishing data-driven and context-specific management guidelines, promoting creative clinical interventions, and advocacy.

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Recommendations for infection management in patients with sepsis and septic shock in resource-limited settings

Cited by 23 publications

References 12 publications

A National Survey of Resources to Address Sepsis in Children in Tertiary Care Centers in Nigeria

A National Survey of Resources to Address Sepsis in Children in Tertiary Care Centers in Nigeria

Timing of antibiotic administration and lactate measurement in septic shock patients: a comparison between hospital wards and the emergency department

The global burden of sepsis: barriers and potential solutions

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