A Longitudinal, Observational Study of Etiology and Long-Term Outcomes of Sepsis in Malawi Revealing the Key Role of Disseminated Tuberculosis
| Autor: | Tim Brooks, Jane Mallewa, Lucy Keyala, Grace Katha, Madlitso Mphasa, Matthew Catton, Nicholas A. Feasey, Jamie Rylance, Melita A. Gordon, Brian Faragher, Emma L. Smith, Joseph M. Lewis, Jackie Duggan, Stephen B. Gordon, Rachel Banda |
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| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
Adult medicine.medical_specialty Malawi Tuberculosis HIV Infections Sepsis Antibiotic resistance Internal medicine medicine Humans business.industry Organ dysfunction Bayes Theorem medicine.disease Anti-Bacterial Agents Malaria Infectious Diseases Etiology Ceftriaxone medicine.symptom business medicine.drug Cohort study |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 74(10) |
| ISSN: | 1537-6591 |
| Popis: | Background Sepsis protocols in sub-Saharan Africa are typically extrapolated from high-income settings, yet sepsis in sub-Saharan Africa is likely caused by distinct pathogens and may require novel treatment strategies. Data to guide such strategies are lacking. We aimed to define causes and modifiable factors associated with sepsis outcomes in Blantyre, Malawi, in order to inform the design of treatment strategies tailored to sub-Saharan Africa. Methods We recruited 225 adults who met a sepsis case definition defined by fever and organ dysfunction in an observational cohort study at a single tertiary center. Etiology was defined using culture, antigen detection, serology, and polymerase chain reaction. The effect of treatment on 28-day outcomes was assessed using Bayesian logistic regression. Results There were 143 of 213 (67%) participants living with human immunodeficiency virus (HIV). We identified a diagnosis in 145 of 225 (64%) participants, most commonly tuberculosis (TB; 34%) followed by invasive bacterial infections (17%), arboviral infections (13%), and malaria (9%). TB was associated with HIV infection, whereas malaria and arboviruses with the absence of HIV infection. Antituberculous chemotherapy was associated with survival (adjusted odds ratio for 28-day death, 0.17; 95% credible interval, 0.05–0.49 for receipt of antituberculous therapy). Of those with confirmed etiology, 83% received the broad-spectrum antibacterial ceftriaxone, but it would be expected to be active in only 24%. Conclusions Sepsis in Blantyre, Malawi, is caused by a range of pathogens; the majority are not susceptible to the broad-spectrum antibacterials that most patients receive. HIV status is a key determinant of etiology. Novel antimicrobial strategies for sepsis tailored to sub-Saharan Africa, including consideration of empiric antituberculous therapy in individuals living with HIV, should be developed and trialed. |
| Databáze: | OpenAIRE |
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