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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The impact of early monitored management on survival in hospitalized adult Ugandan patients with severe sepsis: A prospective intervention study
Critical Care Medicine, Volume 40, No. 7, Year 2012
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Description
In sub-Saharan Africa, sepsis is an important cause of mortality. Optimal sepsis management including fluid resuscitation, early antibiotic administration, and patient monitoring is limited by lack of supplies and skilled health workers. Objective: To evaluate whether early, monitored sepsis management provided by a study medical officer can improve survival among patients with severe sepsis admitted to two public hospitals in Uganda. Design, Setting, and Patients: A prospective before and after study of an intervention cohort (n = 426) with severe sepsis receiving early, monitored sepsis management compared to an observation cohort (n = 245) of similarly ill patients with severe sepsis receiving standard management after admission to the medical wards of two Ugandan hospitals. INTERVENTION:: Early sepsis management provided by a dedicated study medical officer comprising fluid resuscitation, early antibiotics, and regular monitoring in the first 6 hrs of hospitalization. Measurements: Kaplan-Meier survival and unadjusted and adjusted Cox proportional hazards analysis were used to compare the effect of early, monitored sepsis management on 30-day mortality between the intervention cohort (enrolled May 2008 to May 2009) and observation cohort (enrolled July 2006 to November 2006). Results: The majority (86%) of patients in both cohorts were human immuno-deficiency virus-infected. Median fluid volume provided in the first 6 hrs of hospitalization was higher in intervention than observation cohort patients (3000 mL vs. 500 mL, p < .001) and a greater proportion of intervention cohort patients received antibacterial therapy in <1 hr (67% vs. 30.4%, p < .001). Mortality at 30 days was significantly lower in the intervention cohort compared to the observation cohort (33.0% vs. 45.7%, log-rank p = .005). After adjustment for potential confounders, the hazard of 30-day mortality was 26% less in the intervention cohort compared to the observation cohort (adjusted hazards ratio 0.74, 95% confidence interval 0.55-0.98). Mortality among the 13% of intervention patients who developed signs of respiratory distress was associated with baseline illness severity rather than fluid volume administered. CONCLUSION:: Early, monitored management of severely septic patients in Uganda improves survival and is feasible and safe even in a busy public referral hospital. © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Authors & Co-Authors
Jacob, Shevin T.
United States, Seattle
University of Washington
Banura, Patrick
Uganda, Masaka
Masaka Regional Referral Hospital
Baeten, Jared M.
United States, Seattle
University of Washington
Moore, Christopher Charles
United States, Charlottesville
University of Virginia
Meya, David B.
Uganda, Kampala
Makerere University
Nakiyingi, Lydia
Uganda, Kampala
Makerere University
Burke, Rebecca
United States, Durham
Duke University
Horton, Cheryl Lynn
United States, Boston
Harvard Medical School
Iga, Boaz
Uganda, Kalisizo
Rakai Health Sciences Program
Wald, Anna
United States, Seattle
University of Washington
United States, Seattle
Fred Hutchinson Cancer Research Center
Reynolds, Steven James
Uganda, Kalisizo
Rakai Health Sciences Program
United States, Bethesda
National Institute of Allergy and Infectious Diseases Niaid
United States, Baltimore
Johns Hopkins School of Medicine
Mayanja-Kizza, Harriet
Uganda, Kampala
Makerere University
Scheld, William Michael
United States, Charlottesville
University of Virginia
Statistics
Citations: 117
Authors: 13
Affiliations: 10
Identifiers
Doi:
10.1097/CCM.0b013e31824e65d7
ISSN:
00903493
e-ISSN:
15300293
Research Areas
Environmental
Health System And Policy
Study Design
Randomised Control Trial
Cohort Study
Study Locations
Uganda