Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study

doi:10.1186/s40560-019-0407-z

. 2019 Dec 2:7:55.

doi: 10.1186/s40560-019-0407-z. eCollection 2019.

Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study

Kristina E Rudd ^{1

2

3}, Viriya Hantrakun ⁴, Ranjani Somayaji ^{2

5}, Suchart Booraphun ⁶, Chaiyaporn Boonsri ⁶, Annette L Fitzpatrick ⁷, Nicholas P J Day ^{4

8}, Prapit Teparrukkul ⁶, Direk Limmathurotsakul ^{4

8}, T Eoin West ^{1

2}

Affiliations

¹ 1International Respiratory and Severe Illness Center, University of Washington, Seattle, WA USA.
² 2Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA USA.
³ 3Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA.
⁴ 4Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand.
⁵ 5Department of Medicine, The University of Calgary, Calgary, Alberta Canada.
⁶ Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
⁷ 7Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, WA USA.
⁸ 8Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

PMID: 31827803
PMCID: PMC6886203
DOI: 10.1186/s40560-019-0407-z

Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study

Kristina E Rudd et al. J Intensive Care. 2019.

. 2019 Dec 2:7:55.

doi: 10.1186/s40560-019-0407-z. eCollection 2019.

Authors

Kristina E Rudd ^{1

2

3}, Viriya Hantrakun ⁴, Ranjani Somayaji ^{2

5}, Suchart Booraphun ⁶, Chaiyaporn Boonsri ⁶, Annette L Fitzpatrick ⁷, Nicholas P J Day ^{4

8}, Prapit Teparrukkul ⁶, Direk Limmathurotsakul ^{4

8}, T Eoin West ^{1

2}

Affiliations

¹ 1International Respiratory and Severe Illness Center, University of Washington, Seattle, WA USA.
² 2Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA USA.
³ 3Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA USA.
⁴ 4Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400 Thailand.
⁵ 5Department of Medicine, The University of Calgary, Calgary, Alberta Canada.
⁶ Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
⁷ 7Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, WA USA.
⁸ 8Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

PMID: 31827803
PMCID: PMC6886203
DOI: 10.1186/s40560-019-0407-z

Abstract

Background: The burden of sepsis is highest in low- and middle-income countries, though the management of sepsis in these settings is poorly characterized. Therefore, the objective of this study was to assess the early management of sepsis in Thailand.

Methods: Pre-planned analysis of the Ubon-sepsis study, a single-center prospective cohort study of Thai adults admitted to the general medical wards and medical intensive care units (ICUs) of a regional referral hospital with community-acquired sepsis.

Results: Between March 2013 and January 2017, 3,716 patients with sepsis were enrolled. The median age was 59 years (IQR 44-72, range 18-101), 58% were male, and 88% were transferred from other hospitals. Eighty-six percent of patients (N = 3,206) were evaluated in the Emergency Department (ED), where median length of stay was less than 1 hour. Within the first day of admission, most patients (83%, N = 3,089) were admitted to the general medical wards, while 17% were admitted to the ICUs. Patients admitted to the ICUs had similar age, gender, and comorbidities, but had more organ dysfunction and were more likely to receive measured sepsis management interventions. Overall, 84% (N = 3,136) had blood cultures ordered and 89% (N = 3,308) received antibiotics within the first day of hospital admission. Among the 3,089 patients admitted to the general medical wards, 38% (N = 1,165) received an adrenergic agent, and 21% (N = 650) received invasive mechanical ventilation. Overall mortality at 28 days was 21% (765/3,716), and 28-day mortality in patients admitted to the ICUs was higher than that in patients admitted to the general medical wards within the first day (42% [263/627] vs. 16% [502/3,089], p < 0.001).

Conclusions: Sepsis in a regional referral hospital in rural Thailand, where some critical care resources are limited, is commonly managed on general medical wards despite high rates of respiratory failure and shock. Enhancing sepsis care in the ED and general wards, as well as improving access to ICUs, may be beneficial in reducing mortality.

Trial registration: The Ubon-sepsis study was registered on clinicaltrials.gov (NCT02217592).

Keywords: Critical care; Global health; Management; Sepsis; Thailand.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1

Fig. 1

Kaplan-Meier curve demonstrating 28-day survival by admitting location

See this image and copyright information in PMC

References

1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
1. Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis – current estimates and limitations. Am J Respir Crit Care Med. 2016;193:253–272. doi: 10.1164/rccm.201504-0781OC. - DOI - PubMed
1. Cheng AC, West TE, Limmathurotsakul D, Peacock SJ. Strategies to reduce mortality from bacterial sepsis in adults in developing countries. PLoS Med. 2008;5:1173–1179. doi: 10.1371/journal.pmed.0050175. - DOI - PMC - PubMed
1. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45:486–552. doi: 10.1097/CCM.0000000000002255. - DOI - PubMed
1. Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167–1174. doi: 10.1097/CCM.0b013e31827c09f8. - DOI - PubMed

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[1] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed

[2] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315:801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed

[3] Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis – current estimates and limitations. Am J Respir Crit Care Med. 2016;193:253–272. doi: 10.1164/rccm.201504-0781OC. - DOI - PubMed

[4] Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis – current estimates and limitations. Am J Respir Crit Care Med. 2016;193:253–272. doi: 10.1164/rccm.201504-0781OC. - DOI - PubMed

[5] Cheng AC, West TE, Limmathurotsakul D, Peacock SJ. Strategies to reduce mortality from bacterial sepsis in adults in developing countries. PLoS Med. 2008;5:1173–1179. doi: 10.1371/journal.pmed.0050175. - DOI - PMC - PubMed

[6] Cheng AC, West TE, Limmathurotsakul D, Peacock SJ. Strategies to reduce mortality from bacterial sepsis in adults in developing countries. PLoS Med. 2008;5:1173–1179. doi: 10.1371/journal.pmed.0050175. - DOI - PMC - PubMed

[7] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45:486–552. doi: 10.1097/CCM.0000000000002255. - DOI - PubMed

[8] Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45:486–552. doi: 10.1097/CCM.0000000000002255. - DOI - PubMed

[9] Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167–1174. doi: 10.1097/CCM.0b013e31827c09f8. - DOI - PubMed

[10] Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167–1174. doi: 10.1097/CCM.0b013e31827c09f8. - DOI - PubMed

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Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study

Affiliations

Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical