The long sepsis journey in low- and middle-income countries begins with a first step...but on which road?

Kwizera, Arthur; Baelani, Inipavudu; Mer, Mervyn; Kissoon, Niranjan; Schultz, Marcus J.; Patterson, Andrew J.; Musa, Ndidiamaka; Farmer, Joseph C.; Dünser, Martin W.

doi:10.1186/s13054-018-1987-z

Cited by 14 publications

(21 citation statements)

References 11 publications

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“…In this study evaluating patients with community-acquired sepsis, enrollment into a programme to identify and initiate sepsis care implemented at the study hospital (SFT programme) was associated with 28% lower risk of mortality. In recent years, there has been an increasing need to understand benefit and cost effectiveness of implementation of sepsis care interventions in LMICs because of concerns that international sepsis guidelines 11 may not be extrapolated to patients with tropical infectious diseases [7][8][9] and to resource-limited settings with poor ICU capacity. 10 In this study, we show the effectiveness of sepsis protocol modified based on resource availability in a tropical country, where causes of community-acquired sepsis include malaria and tropical viral diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Patients in the SFT group are monitored closely either in or outside the ICUs, and the attending physicians aim to obviate the need for airway intubation when possible. 7 Attending physicians may tend to provide mechanical ventilation to patients in the non-exposed group based on broad indications such as (1) airway protection, (2) hypercapnic respiratory failure, (3) hypoxemic Open access respiratory failure or (4) circulatory failure 23 24 because they may not be able to monitor patients' breathing and oxygen saturation as often as those enrolled in the SFT programme.…”

Section: Discussionmentioning

confidence: 99%

“…The implementation of the SFT programme in our study hospital and in Thailand is consistent with the recommendation of 'SCAN-TEACH-TREAT' programme developed by Sepsis in Resource-Limited Settings Workgroup of the Surviving Sepsis Campaign. 7 The SFT programme evaluated resources in the setting (SCAN component), focused on educational interventions on early recognition and management of sepsis among medical personnel including physicians, nurses and students (TEACH component) and implemented pragmatic and simple bundles into practice (TREAT component). In addition, the SFT programme has the strong support and endorsement of local health and governmental leaders.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…Open access those developed by the Surviving Sepsis Campaign (SSC) have been associated with reduced mortality in highincome countries, [2][3][4] but effectiveness of these guidelines in LMICs needs more evaluation. [7][8][9][10] Following the SSC 2012, 11 the Ministry of Public Health Thailand and the Thai Society of Critical Care Medicine developed local recommendations on sepsis based on resource availability and local context. 12 The recommendations suggest that secondary-care and tertiary-care hospitals in the country should develop a Sepsis Fast Track (SFT) so that, on presentation, sepsis patients can be identified, treated and directly admitted to the intensive care units (ICUs) when available.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis)

et al. 2021

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ObjectiveTo evaluate the effectiveness of a Sepsis Fast Track (SFT) programme initiated at a regional referral hospital in Thailand in January 2015.DesignA retrospective analysis using the data of a prospective observational study (Ubon-sepsis) from March 2013 to January 2017.SettingGeneral medical wards and medical intensive care units (ICUs) of a study hospital.ParticipantsPatients with community-acquired sepsis observed under the Ubon-sepsis cohort. Sepsis was defined as modified Sequential Organ Failure Assessment (SOFA) Score ≥2.Main exposureThe SFT programme was a protocol to identify and initiate sepsis care on hospital admission, implemented at the study hospital in 2015. Patients in the SFT programme were admitted directly to the ICUs when available. The non-exposed group comprised of patients who received standard of care.Main outcomeThe primary outcome was 28-day mortality. The secondary outcomes were measured sepsis management interventions.ResultsOf 3806 sepsis patients, 903 (24%) were detected and enrolled in the SFT programme of the study hospital (SFT group) and 2903 received standard of care (non-exposed group). Patients in the SFT group had more organ dysfunction, were more likely to receive measured sepsis management and to be admitted directly to the ICU (19% vs 4%). Patients in the SFT group were more likely to survive (adjusted HR 0.72, 95% CI 0.58 to 0.88, p=0.001) adjusted for admission year, gender, age, comorbidities, modified SOFA Score and direct admission to the ICUs.ConclusionsThe SFT programme is associated with improved sepsis care and lower risk of death in sepsis patients in rural Thailand, where some critical care resources are limited. The survival benefit is observed even when all patients enrolled in the programme could not be admitted directly into the ICUs.Trial registration numberNCT02217592.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Comparison With Other Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis)

et al. 2021

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“…In the same year, 48.9 million cases of sepsis and 11 million deaths were recorded worldwide (1). The burden of sepsis weighs heavier on low and lower-middle income countries due to poorer healthcare infrastructures (2).…”

Section: Introductionmentioning

confidence: 99%

Metagenomic evidence for a polymicrobial signature of sepsis

Tan

Acman

Dorp

et al. 2020

Preprint

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12Sepsis is defined as a life-threatening organ dysfunction arising from a dysregulated host response to 13 infection. The last two decades have seen significant progress in our understanding of the host component 14 of sepsis. However, detailed study of the composition of the microbial community present in sepsis, or 15 indeed, the finer characterisation of this community as a predictive tool to identify sepsis cases, has only 16 received limited attention. The microbial component of sepsis has been attributed to a heterogenous array 17 of pathogens, usually identified through targeted culture. Metagenomic sequencing of microbial cell-free 18 DNA (cfDNA) offers opportunities to instead classify the full spectrum of microorganisms in a clinical 19 sample. In this study, we statistically characterise the microbial component of sepsis using microbial 20 taxonomic assignments from metagenomes generated from blood samples collected in septic and healthy 21 patients. Using gradient-boosted tree classifiers, we demonstrate the remarkable performance of microbial 22 abundances alone to identify patients with sepsis (AUROC = 0.999; 95% CI 0.997-1.000). Additionally, 23 we demonstrate the promising application of Shapley Additive exPlanations (SHAP), a recently developed 24 model interpretation approach, to reduce sepsis into a set of 23 genera sufficient for diagnosis (AUROC 25 = 0.959; 95% CI 0.903-0.991) and to aid in determining which pathogens contribute most to each 26 diagnosis. While the prevailing clinical diagnostic paradigms seek to identify single causative agents, we 27 instead find evidence for a polymicrobial signature of sepsis using unsupervised clustering, gradient-28 boosted tree classifiers and microbial network analysis. We anticipate that this polymicrobial signature 29 can provide insights into the nature of microbial infection during sepsis and yield predictions which can 30 ultimately be leveraged as a clinically useful tool. In light of these results, we provide some 31 recommendations for future work involving metagenomic sequencing of blood samples. 32 3 Author summary 33 Sepsis is a leading cause of death globally, responsible for an estimated six million deaths every year. 34 Current definitions and research efforts have predominately focused on understanding the host's response 35 to sepsis and developing faster diagnostics, predictive tools and treatments. The role of the resident and 36 pathogenic microbial community in contributing to disease status is more poorly characterised. The advent 37 of large scale metagenomic sequencing of clinical samples offers new opportunities to characterise the 38 species contributing to systemic infections, and unlike culture-based methods is not limited to organisms 39that are fast-growing or culturable. We analysed a publicly available metagenomic dataset, comparing the 40 patterns of microbial DNA in the blood plasma of septic patients relative to that of healthy individuals. 41Our results provide evidence that septic infections tend to be ...

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Shared Decision-Making (I): Within the Interprofessional Team

Michalsen

Jensen

2023

Lessons From the ICU

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The long sepsis journey in low- and middle-income countries begins with a first step...but on which road?

Cited by 14 publications

References 11 publications

Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis)

Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis)

Metagenomic evidence for a polymicrobial signature of sepsis

Shared Decision-Making (I): Within the Interprofessional Team

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