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Fuchs A, Tufa TB, Hörner J, Hurissa Z, Nordmann T, Bosselmann M, Abdissa S, Sorsa A, Orth HM, Jensen BEO, MacKenzie C, Pfeffer K, Kaasch AJ, Bode JG, Häussinger D, Feldt T. Clinical and microbiological characterization of sepsis and evaluation of sepsis scores. PLoS One 2021; 16:e0247646. [PMID: 33661970 PMCID: PMC7932074 DOI: 10.1371/journal.pone.0247646] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/10/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite the necessity of early recognition for an optimal outcome, sepsis often remains unrecognized. Available tools for early recognition are rarely evaluated in low- and middle-income countries. In this study, we analyzed the spectrum, treatment and outcome of sepsis at an Ethiopian tertiary hospital and evaluated recommended sepsis scores. Methods Patients with an infection and ≥2 SIRS criteria were screened for sepsis by SOFA scoring. From septic patients, socioeconomic and clinical data as well as blood cultures were collected and they were followed until discharge or death; 28-day mortality was determined. Results In 170 patients with sepsis, the overall mortality rate was 29.4%. The recognition rate by treating physicians after initial clinical assessment was low (12.4%). Increased risk of mortality was significantly associated with level of SOFA and qSOFA score, Gram-negative bacteremia (in comparison to Gram-positive bacteremia; 42.9 versus 16.7%), and antimicrobial regimen including ceftriaxone (35.7% versus 19.2%) or metronidazole (43.8% versus 25.0%), but not with an increased respiratory rate (≥22/min) or decreased systolic blood pressure (≤100mmHg). In Gram-negative isolates, extended antimicrobial resistance with expression of extended-spectrum beta-lactamase and carbapenemase genes was common. Among adult patients, sensitivity and specificity of qSOFA score for detection of sepsis were 54.3% and 66.7%, respectively. Conclusion Sepsis is commonly unrecognized and associated with high mortality, showing the need for reliable and easy-applicable tools to support early recognition. The established sepsis scores were either of limited applicability (SOFA) or, as in the case of qSOFA, were significantly impaired in their sensitivity and specificity, demonstrating the need for further evaluation and adaptation to local settings. Regional factors like malaria endemicity and HIV prevalence might influence the performance of different scores. Ineffective empirical treatment due to antimicrobial resistance is common and associated with mortality. Local antimicrobial resistance statistics are needed for guidance of calculated antimicrobial therapy to support reduction of sepsis mortality.
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Affiliation(s)
- Andre Fuchs
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Hirsch Institute of Tropical Medicine, Asella, Ethiopia
| | - Tafese Beyene Tufa
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Hirsch Institute of Tropical Medicine, Asella, Ethiopia
- College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Johannes Hörner
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Zewdu Hurissa
- College of Health Sciences, Arsi University, Asella, Ethiopia
| | | | | | - Sileshi Abdissa
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Hirsch Institute of Tropical Medicine, Asella, Ethiopia
- College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Abebe Sorsa
- College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Hans Martin Orth
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Hirsch Institute of Tropical Medicine, Asella, Ethiopia
| | - Björn-Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Colin MacKenzie
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Klaus Pfeffer
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Achim J. Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital Magdeburg, Otto-von-Guericke-University, Magdeburg, Germany
| | - Johannes G. Bode
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Hirsch Institute of Tropical Medicine, Asella, Ethiopia
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Hirsch Institute of Tropical Medicine, Asella, Ethiopia
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- Hirsch Institute of Tropical Medicine, Asella, Ethiopia
- * E-mail:
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