Availability of resources to treat sepsis in Brazil: a random sample of Brazilian institutions

Abstract

Objective To characterize resource availability from a nationally representative random sample of intensive care units in Brazil. Methods A structured online survey of participating units in the Sepsis PREvalence Assessment Database (SPREAD) study, a nationwide 1-day point prevalence survey to assess the burden of sepsis in Brazil, was sent to the medical director of each unit. Results A representative sample of 277 of the 317 invited units responded to the resources survey. Most of the hospitals had fewer than 500 beds (94.6%) with a median of 14 beds in the intensive care unit. Providing care for public-insured patients was the main source of income in two-thirds of the surveyed units. Own microbiology laboratory was not available for 26.8% of the surveyed intensive care units, and 10.5% did not always have access to blood cultures. Broad spectrum antibiotics were not always available in 10.5% of surveyed units, and 21.3% could not always measure lactate within three hours. Those institutions with a high resource availability (158 units, 57%) were usually larger and preferentially served patients from the private health system compared to institutions without high resource availability. Otherwise, those without high resource availability did not always have broad-spectrum antibiotics (24.4%), vasopressors (4.2%) or crystalloids (7.6%). Conclusion Our study indicates that a relevant number of units cannot perform basic monitoring and therapeutic interventions in septic patients. Our results highlight major opportunities for improvement to adhere to simple but effective interventions in Brazil.

Leptospirosis: one of the forgotten diseases

“…Since severe leptospirosis is a cause of sepsis (i.e. infection with organ dysfunction), lower availability of treatment resources are detrimental and unfortunately common in LMICs [10,11]. The present study from Miailhe et al reinforce that leptospirosis, albeit uncommon in some parts of the world, can have good outcomes if properly treated, but much worse outcomes in other areas with treatment resource limitations.…”

The Effects of Dexmedetomidine in a Rat Model of Sepsis-Induced Lung Injury are Mediated Through the Adenosine Monophosphate-Activated Protein Kinase (AMPK)/Silent Information Regulator 1 (SIRT1) Pathway

“…Sepsis is extremely dangerous, and the mortality rate is high. Worldwide, according to the World Health Organisation (WHO), there are millions of deaths from sepsis each year [12]. Li et al [13] showed that fever in patients with sepsis is a secondary reaction resulting from the release of endogenous pyrogens that include IL-1b and IL-6 from the activation of macrophages in vivo.…”

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021

“…However, lactate alone is neither sensitive nor specific enough to rule-in or rule-out the diagnosis on its own. Lactate testing may not be readily available in many resource-limited settings [54][55][56][57][58][59][60][61]. Therefore, we issued a weak recommendation favouring the use of serum lactate as an adjunctive test to modify the pretest probability of sepsis in patients with suspected but not confirmed sepsis.…”