Epidemiology and Outcome of Sepsis in Adults and Children in a Rural, Sub-Sahara African Setting.

• Type of Material: Article
• Authors: Arthur Kwizera, Makerere University; Olivier Urayeneza, Gitwe Hospital; Pierre Mujyarugamba, Gitwe Hospital; Inipavudu Baelani, Great Lakes Free University; Jens Meier, Kepler University; Mervyn Mer, University of the Witwatersrand; Ndidiamaka Musa, University of Washington; Niranjan Kissoon, University of British Columbia; Andrew Patterson, Emory University; Joseph C. Farmer, Mayo Clinic; Martin W. Dünser, Kepler University
• Language: English
• Date: 2021-12
• Publisher: Society of Critical Care Medicine
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/CCE.0000000000000592
• Title of Journal or Parent Work: Crit Care Explor
• Volume: 3
• Issue: 12
• Start Page: e0592
• End Page: e0592
• Grant/Funding Information: Supported, in part, by the Life Priority Fund, the Hellman Foundation, and the King Baudouin Foundation. Also supported, in part, by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine through the Surviving Sepsis Campaign.; Dr. Mer received funding from Pfizer and Sanofi Aventis. Drs. Patterson’s and Dünser’s institutions received funding from the Hellman Foundation; they received support for article research from the Society of Critical Care Medicine through the Surviving Sepsis Campaign. Dr. Patterson’s institution received funding from the European Society of Intensive Care Medicine; he received funding from the American Board of Anesthesiology, the Accreditation Council for Graduate Medical Education, and Contagion Solutions, LCC. Dr. Farmer received funding from REES, VinMec International Healthcare, and Avera eCARE; he disclosed that he is a member of REES Architecture, Ambient Clinical Analytics, Arche Healthcare, VinMec International Healthcare, Avera eCARE, and the president of BOD Trajectory Group. Dr. Dünser’s institution received funding from the Life Priority Fund and the King Baudouin Foundation; he received support for article research from the European society of Intensive Care Medicine. The remaining authors have disclosed that they do not have any potential conflicts of interest.
• Keywords: Africa; sepsis; malaria; Rwanda; outcome; epidemiology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

OBJECTIVES: To identify the epidemiology and outcome of adults and children with and without sepsis in a rural sub-Sahara African setting. DESIGN: A priori planned substudy of a prospective, before-and-after trial. SETTING: Rural, sub-Sahara African hospital. PATIENTS: One-thousand four-hundred twelve patients (adults, n = 491; children, n = 921) who were admitted to hospital because of an acute infection. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic, clinical, laboratory data, danger signs, and the presence of sepsis (defined as a quick Sequential Organ Failure Assessment score count ≥ 2) at admission were extracted. Sepsis was observed in 69 adults (14.1%) and 248 children (26.9%). Sepsis patients differed from subjects without sepsis in several demographic and clinical aspects. Malaria was the most frequent type of infection in adults (66.7%) and children (63.7%) with sepsis, followed by suspected bacterial and parasitic infections other than malaria. Adults with sepsis more frequently developed respiratory failure (8.7% vs 2.1%; p = 0.01), had a higher in-hospital mortality (17.4% vs 8.3%; p < 0.001), were less often discharged home (81.2% vs 92.2%; p = 0.007), and had higher median (interquartile range) costs of care (30,300 [19,400-49,900] vs 42,500 Rwandan Francs [27,000-64,400 Rwandan Francs]; p = 0.004) than adults without sepsis. Children with sepsis were less frequently discharged home than children without sepsis (93.1% vs 96.4%; p = 0.046). Malaria and respiratory tract infections claimed the highest absolute numbers of lives. The duration of symptoms before hospital admission did not differ between survivors and nonsurvivors in adults (72 [24-168] vs 96 hr [72-168 hr]; p = 0.27) or children (48 [24-72] vs 36 [24-108 hr]; p = 0.8). Respiratory failure and coma were the most common causes of in-hospital death. CONCLUSIONS: In addition to suspected bacterial, viral, and fungal infections, malaria and other parasitic infections are common and important causes of sepsis in adults and children admitted to a rural hospital in sub-Sahara Africa. The in-hospital mortality associated with sepsis is substantial, primarily in adults.