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Chapter 11 : Sepsis in Sub-Saharan Africa
Category: Clinical Microbiology; Bacterial Pathogenesis
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This chapter addresses a number of topics and strategies for managing the septic patient in sub-Saharan Africa (SSA). It focuses on the interaction of malaria and HIV infection with invasive bacterial infections, and highlights the need for different strategies regarding diagnosis and treatment of sepsis due to lack of resources when compared to resource-rich regions where comprehensive but heavily resource-dependent early goal-directed therapy and sepsis “bundles” are the standard of care. The authors of this chapter show that, among Ugandan patients presenting with sepsis, those with the highest expected mortality can be quickly identified through use of a handheld lactate monitor. In a study of lactate in Ugandan septic patients, it was found that a point-of-care device produced more reliable results than standard results from a local private laboratory due to increased discrepancies at higher lactate concentrations. Potential benefits of distributing miniaturized devices and systems designed specifically for low-income countries (LICs) include access to diagnostic tools not previously available and, thus, faster and more accurate diagnoses; better epidemiological data that can be used for disease modeling and vaccine introduction; better utilization of minimally trained healthcare workers; and better use of existing therapeutics. After antimicrobial therapy is begun, the cornerstone of sepsis management is early and adequate fluid resuscitation. Recent animal studies have shown the potential benefit of artemisinins as adjunctive therapy for sepsis. Attention to source control, including drainage of abscesses, may eradicate a nidus of infection.
Receiver operating characteristic curve, with sensitivity on the y axis and 1-specificity on the x axis, for prediction of in-hospital mortality on the basis of different portable whole-blood lactate (PWBL) concentrations. Reprinted from reference 41 (© 2007 by the Infectious Diseases Society of America; all rights reserved).
Typical conditions for intensive care of septic patients found in regional referral hospitals in SSA.
Typical laboratory conditions found adjacent to medical and surgical wards in regional referral hospitals in SSA.
In-hospital mortality due to sepsis at two hospitals in Uganda and admission KPS. Numbers in bars represent numbers of patients. Reprinted from reference 29 .