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dc.contributor.authorJacob, Shevin T.
dc.contributor.authorBanura, Patrick
dc.contributor.authorMoore, Christopher C.
dc.contributor.authorPinkerton, Relana
dc.contributor.authorMeya, David
dc.contributor.authorOpendi, Pius
dc.contributor.authorReynolds, Steven J.
dc.contributor.authorKenya-Mugisha, Nathan
dc.contributor.authorMayanja-Kizza, Harriet
dc.contributor.authorScheld, Michael W.
dc.date.accessioned2012-12-04T12:36:06Z
dc.date.available2012-12-04T12:36:06Z
dc.date.issued2009-11-11
dc.identifier.citationJacob, S.T., Moore, C.C., Banura, P., Pinkerton, R., Meya, D., Opendi, P., Reynolds, S.J., Kenya-Mugisha, N., Mayanja-Kizza, H., Scheld, M.W. (2009). Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population. PLoS One 4(11)en_US
dc.identifier.issn1932-6203
dc.identifier.urihttp://hdl.handle.net/10570/908
dc.descriptionPfizer Initiative in International Health, Division of Intramural Research, NIAID/NIHen_US
dc.description.abstractBackground: Sepsis likely contributes to the high burden of infectious disease morbidity and mortality in low income countries. Data regarding sepsis management in sub-Saharan Africa are limited. We conducted a prospective observational study reporting the management and outcomes of severely septic patients in two Ugandan hospitals. We describe their epidemiology, management, and clinical correlates for mortality. Methodology/Results: Three-hundred eighty-two patients fulfilled enrollment criteria for a severe sepsis syndrome. Vital signs, Management and laboratory results were recorded. Outcomes measured included in-hospital and post-discharge mortality. Most patients were HIV-infected (320/377, 84.9%) with a median CD4+ T cell (CD4) count of 52 cells/mm3 (IQR, 16–131 cells/mm3). Overall mortality was 43.0%, with 23.7% in-hospital mortality (90/380) and 22.3% post-discharge mortality (55/247). Significant predictors of in-hospital mortality included admission Glasgow Coma Scale and Karnofsky Performance Scale (KPS), tachypnea, leukocytosis and thrombocytopenia. Discharge KPS and early fluid resuscitation were significant predictors of post-discharge mortality. Among HIV-infected patients, CD4 count was a significant predictor of post-discharge mortality. Median volume of fluid resuscitation within the first 6 hours of presentation was 500 mLs (IQR 250–1000 mls). Fifty-two different empiric antibacterial regimens were used during the study. Bacteremic patients were more likely to die in hospital than non-bacterium patients (OR 1.83, 95% CI = 1.01–3.33). Patients with Mycobacterium tuberculosis (MTB) bacteremia (25/249) had higher in-hospital mortality (OR 1.97, 95% CI = 1.19–327) and lower median CD4 counts (p = 0.001) than patients without MTB bacteremia. Conclusion: Patients presenting with sepsis syndromes to two Ugandan hospitals had late stage HIV infection and high mortality. Bacteremia, especially from MTB, was associated with increased in-hospital mortality. Most clinical predictors of in hospital mortality were easily measurable and can be used for triaging patients in resource-constrained settings. Procurement of low cost and high impact treatments like intravenous fluids and empiric antibiotics may help decrease sepsis-associated mortality in resource-constrained settings.en_US
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.subjectSepsis syndromeen_US
dc.subjectSub-Saharan Africaen_US
dc.subjectMortalityen_US
dc.subjectEpidemiologyen_US
dc.subjectThrombocytopeniaen_US
dc.subjectHIV-infected patientsen_US
dc.subjectUgandaen_US
dc.subjectData managementen_US
dc.subjectInfectious diseaseen_US
dc.subjectHIV/AIDSen_US
dc.subjectCD4 cell counten_US
dc.titleSevere sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected populationen_US
dc.typeJournal article, peer revieweden_US


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