The clinical characteristics of patients with sepsis in a tertiary referral hospital in Yangon, Myanmar

Lynn, Kyi Lai Ye; Hanson, Josh; Mon, Nan Cho Nwe; Yin, Kyi Nyein; Nyein, Myo Lwin; Thant, Kyaw Zin; Kyi, Mar Mar; Oo, Thin Zar Cho; Aung, Ne Myo

doi:10.1093/trstmh/try115

Cited by 10 publications

(13 citation statements)

References 30 publications

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“…Myanmar has a significant burden of infectious diseases. 5,8,[20][21][22] The Global Fund has invested US$613 million to address malaria, HIV/AIDS and tuberculosis, and this has contributed to malaria incidence declining to the point that elimination is now being discussed, 4 while between 2007 and 2017 mortality from HIV and tuberculosis fell by 67% and 49% respectively. 23,24 However, other infectious diseases in Myanmar remain relatively neglected.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, antimicrobial resistance is rising dramatically in Myanmar . The implications for H. pylori eradication are unclear, although resistance rates of 63% to clarithromycin and 100% to metronidazole have been reported .…”

Section: Introductionmentioning

confidence: 99%

“…Meanwhile, antimicrobial resistance is rising dramatically in Myanmar. 7,8 The implications for H. pylori eradication are unclear, although resistance rates of 63% to clarithromycin and 100% to metronidazole have been reported. 9,10 Consequently, the suitability of Myanmar's currently recommended first-line eradication regimen of 14 days of concomitant clarithromycin/nitroimidazole/amoxycillin and proton pump inhibitor therapy is uncertain.…”

Section: Introductionmentioning

confidence: 99%

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Sequential Helicobacter pylori eradication therapy in Myanmar; a randomized clinical trial of efficacy and tolerability

Myint

Zaw

Sain

et al. 2019

J of Gastro and Hepatol

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Background and Aim There is little published research to examine the best approach to the management of Helicobacter pylori in Myanmar. This study aimed to determine the relative efficacy and tolerability of sequential eradication therapy compared to Myanmar's current recommendation of a concomitant four drug regimen. Methods Patients were screened for H. pylori using monoclonal Stool Antigen Testing (SAT). Those testing positive were randomized 1:1 to receive receive Myanmar's first‐line regimen of 14 days of concomitant rabeprazole, clarithromycin, amoxycillin and tinidazole (140 pills, cost US$23) or 10 days of sequential rabeprazole, clarithromycin, amoxycillin and tinidazole (60 pills, cost US$10). Adherence and adverse effects were recorded, and the efficacy of the regimens assessed with repeat SAT. Results Of the 1011 patients screened for H. pylori infection, 313 (31%) tested positive. There was no statistical difference in the cure rates of the two regimens in either intention‐to‐treat: 128/157 (82%; 95% confidence interval (CI): 75–87%) receiving sequential therapy versus 123/156 (79%; 95% CI: 72–85%) receiving concomitant therapy (P = 0.55) or per‐protocol analysis: 125/131 (95%; 95% CI: 90–98) receiving sequential therapy versus 121/130 (93%; 95% CI: 87–96) receiving concomitant therapy (P = 0.42). Side effects of therapy were reported in 54/157 (47%) patients taking sequential therapy compared with 62/156 (53%) taking concomitant therapy, but this difference did not reach statistical significance (P = 0.33). Conclusions In this high‐burden, resource‐poor setting, less expensive sequential therapy was as effective and as well tolerated as the currently recommended concomitant four drug regimen for eradication of H. pylori.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sequential Helicobacter pylori eradication therapy in Myanmar; a randomized clinical trial of efficacy and tolerability

Myint

Zaw

Sain

et al. 2019

J of Gastro and Hepatol

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“…In both settings, clinicians are taught that patients with rickettsial infection typically defervesce within 48 h of starting appropriate therapy and that other diagnoses should be suspected-and potentially empirically treated-if fever continues (Biggs et al, 2016;Brown et al, 1984;Rovery and Raoult, 2008;Sheehy et al, 1973;Stewart et al, 2017). In tropical, resource-limited settings, there are many lifethreatening pathogensincluding malaria and bacterial sepsisthat may have a similar clinical presentation to rickettsial infections, but which require specificand quite differenttherapy (Ye Lynn et al, 2019). In these locations, where diagnostic support is limited, clinicians necessarily rely more on bedside assessment.…”

Section: Introductionmentioning

confidence: 99%

Prompt defervescence after initiation of treatment for rickettsial infections – time to dispense with the dogma?

Stewart

Smith

Hanson

2021

International Journal of Infectious Diseases

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Introduction: Clinicians are commonly taught that if patients with suspected rickettsial disease have continuing fever after 48 h of anti-rickettsial therapy, an alternative diagnosis is likely. Methods: This retrospective study of patients hospitalised with scrub typhus and Queensland tick typhus (QTT) in tropical Australia, examined the time to defervescence (TTD) after the initiation of the patients' anti-rickettsial therapy. It also identified factors associated with delayed defervescence (TTD >48 h after antibiotic commencement). Results: Of the 58 patients, 32 (56%) had delayed defervescence. The median (interquartile range (IQR)) age of patients with delayed defervescence was 52 (37-62) versus 40 (28-53) years in those who defervesced within 48 h (p = 0.05). Patients with delayed defervescence were more likely to require Intensive Care Unit (ICU) admission than those who defervesced within 48 h (12/32 (38%) versus 3/26 (12%) and p = 0.02). Even among patients not requiring ICU care, patients with delayed defervescence required a longer hospitalisation than those who defervesced within 48 h (median (IQR): 6 (3-8) versus 3 (2-5) days and p = 0.006). Conclusions: A significant proportion of patients with confirmed scrub typhus and QTT will remain febrile for >48 h after appropriate anti-rickettsial therapy. Delayed defervescence is more common in patients with severe disease.

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“…Myanmar is one of the poorest countries in South East Asia and sepsis is the most common cause of in-hospital death (Ye Lynn et al, 2019). Although the country has made significant progress against infections like malaria (Mu et al, 2016), it remains one of the world's 30 high tuberculosis (TB) burden countries (World Health Organization, 2019;Thit, 2017), HIV affects 0.8% of adults aged 15-49 years (UNAIDS, 2018), and antimicrobial resistance is a significant and growing issue (Myat et al, 2020;Ye Lynn et al, 2019). This study was performed to determine the ability of several commonly used disease severity scores to predict the clinical course of patients with evidence of community-acquired sepsis in resource-limited tropical settings like Myanmar.…”

Section: Introductionmentioning

confidence: 99%

The comparative ability of commonly used disease severity scores to predict death or a requirement for ICU care in patients hospitalised with possible sepsis in Yangon, Myanmar

Minn

Aung

Kyaw

et al. 2021

International Journal of Infectious Diseases

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To determine the comparative prognostic utility of commonly used disease prediction scores in adults with presumed community-acquired sepsis in a resource-limited tropical setting. Methods: This prospective, observational study was performed on the medical ward of a tertiary-referral hospital in Yangon, Myanmar. The ability of the National Early Warning Score 2 (NEWS2), quick NEWS (qNEWS), quick Sequential Organ Failure Assessment (qSOFA) score, Universal Vital Assessment (UVA) and Sequential Organ Failure Assessment (SOFA) scores to predict a complicated inpatient course (death or requirement for intensive care unit (ICU) support) in patients with two or more systemic inflammatory response syndrome criteria was determined. Results: Among the 509 patients, 30 (6%) were HIV-seropositive. The most commonly confirmed diagnoses were tuberculosis (30/509, 5.9%) and measles (26/509, 5.1%). Overall, 75/509 (14.7%) died or required ICU support. All the scores except the qSOFA score, which was inferior, had a similar ability to predict a complicated inpatient course. Conclusions: In this resource-limited tropical setting, disease severity scores calculated at presentation using only vital signs-such as the NEWS2 score-identified high-risk sepsis patient as well as the SOFA score, which is calculated at 24 h and which also requires laboratory data. Use of these simple clinical scores can be used to facilitate recognition of the high-risk patient and to optimise the use of finite resources.

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The clinical characteristics of patients with sepsis in a tertiary referral hospital in Yangon, Myanmar

Cited by 10 publications

References 30 publications

Sequential Helicobacter pylori eradication therapy in Myanmar; a randomized clinical trial of efficacy and tolerability

Sequential Helicobacter pylori eradication therapy in Myanmar; a randomized clinical trial of efficacy and tolerability

Prompt defervescence after initiation of treatment for rickettsial infections – time to dispense with the dogma?

The comparative ability of commonly used disease severity scores to predict death or a requirement for ICU care in patients hospitalised with possible sepsis in Yangon, Myanmar

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