Clinical and microbiological characterization of sepsis and evaluation of sepsis scores.
Adolescent
Adult
Aged
Anti-Bacterial Agents
/ therapeutic use
Bacteria
/ classification
Candida
/ drug effects
Clindamycin
/ therapeutic use
Cross-Sectional Studies
Drug Resistance
Ethiopia
Female
Hospital Mortality
Humans
Male
Middle Aged
Plasmodium
/ drug effects
Prognosis
Prospective Studies
Sepsis
/ drug therapy
Trimethoprim, Sulfamethoxazole Drug Combination
/ therapeutic use
Young Adult
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
24
04
2020
accepted:
10
02
2021
entrez:
4
3
2021
pubmed:
5
3
2021
medline:
10
9
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33661970
doi: 10.1371/journal.pone.0247646
pii: PONE-D-20-11929
pmc: PMC7932074
doi:
Substances chimiques
Anti-Bacterial Agents
0
Clindamycin
3U02EL437C
Trimethoprim, Sulfamethoxazole Drug Combination
8064-90-2
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0247646Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Lancet Infect Dis. 2017 Oct;17(10):1042-1052
pubmed: 28818544
JAMA. 2014 Apr 2;311(13):1308-16
pubmed: 24638143
PLoS One. 2009 Nov 11;4(11):e7782
pubmed: 19907656
J Crit Care. 2017 Dec;42:12-17
pubmed: 28647650
Pan Afr Med J. 2015 Aug 31;21:323
pubmed: 26587170
PLoS One. 2017 Feb 15;12(2):e0171422
pubmed: 28199348
Crit Care. 2011;15(1):R10
pubmed: 21219619
Crit Care Med. 2017 Mar;45(3):486-552
pubmed: 28098591
Prehosp Emerg Care. 2017 Jul-Aug;21(4):489-497
pubmed: 28121217
Crit Care Med. 2018 Nov;46(11):e1029-e1039
pubmed: 30095495
Int J Epidemiol. 1995 Oct;24(5):977-83
pubmed: 8557456
Proc Natl Acad Sci U S A. 2007 May 15;104 Suppl 1:8655-60
pubmed: 17494744
J Obstet Gynaecol. 2018 Jul;38(5):635-641
pubmed: 29447024
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
Pediatr Infect Dis J. 2015 Jan;34(1):e1-8
pubmed: 25389919
Pediatr Infect Dis J. 2016 Jul;35(7):e191-8
pubmed: 27031259
PLoS One. 2017 Apr 13;12(4):e0175456
pubmed: 28406949
Crit Care. 2017 Mar 26;21(1):73
pubmed: 28342442
BMC Infect Dis. 2017 Mar 1;17(1):180
pubmed: 28249575
Emerg Infect Dis. 2014 Mar;20(3):434-41
pubmed: 24564906
Ann Intern Med. 2019 Oct 15;171(8):547-554
pubmed: 31525774
J Crit Care. 2016 Feb;31(1):58-62
pubmed: 26601855
PLoS Med. 2008 Aug 19;5(8):e175
pubmed: 18752342
J Infect. 2015 Jan;70(1):11-9
pubmed: 25043393
Pediatr Infect Dis J. 2009 Jan;28(1 Suppl):S19-21
pubmed: 19106758
Crit Care Med. 2013 Feb;41(2):580-637
pubmed: 23353941
Intensive Care Med. 2017 May;43(5):612-624
pubmed: 28349179
Antimicrob Agents Chemother. 2013 Oct;57(10):5162-5
pubmed: 23877696
Crit Care Med. 1998 Nov;26(11):1793-800
pubmed: 9824069
J Crit Care. 2018 Aug;46:115-118
pubmed: 29310974
Chest. 1992 Jun;101(6):1644-55
pubmed: 1303622
BMC Infect Dis. 2018 Oct 20;18(1):524
pubmed: 30342476
Scand J Trauma Resusc Emerg Med. 2017 Jun 9;25(1):56
pubmed: 28599661
Lancet. 2016 Jan 9;387(10014):168-75
pubmed: 26603918
J Antimicrob Chemother. 2015 Mar;70(3):710-5
pubmed: 25414200
JAMA. 2017 Jan 17;317(3):267-268
pubmed: 28114531
BMC Infect Dis. 2018 Jan 19;18(1):47
pubmed: 29351771
Proc Natl Acad Sci U S A. 1998 Nov 24;95(24):14009-14
pubmed: 9826643
J Crit Care. 2016 Jun;33:78-83
pubmed: 26994777
Crit Care Med. 2014 Mar;42(3):625-31
pubmed: 24201173
Emerg Infect Dis. 2018 Jan;24(1):174-175
pubmed: 29260682
Chest. 2017 Mar;151(3):586-596
pubmed: 27876592
JAMA. 2016 Feb 23;315(8):762-74
pubmed: 26903335
Implement Sci. 2017 Nov 6;12(1):126
pubmed: 29110667