Department of Clinical Sciences, Liverpool School of Tropical Medicine and Aintree University Hospital NHS Foundation Trust, Liverpool L9 7AL, UK.
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
Int J Environ Res Public Health. 2018 Sep 15;15(9):2017. doi: 10.3390/ijerph15092017.
Sepsis is a common cause of morbidity and mortality in sub-Saharan African adults. Standardised management pathways have been documented to improve the survival of adults with sepsis from high-resource settings. Our aim was to assess the current evidence base for early sepsis interventions (recognition, empirical antibiotics, and resuscitation) in resource-poor settings of sub-Saharan Africa. We searched MEDLINE, EMBASE and CINHAL Plus databases to identify interventional studies for the early recognition and management of sepsis in sub-Saharan Africa (1 January 2000 to 1 August 2018) using a protocol-driven search strategy: adults, protocolised care pathway, and sub-Saharan Africa. We identified 725 publications of which three met criteria for final selection. Meta-analysis from two randomised controlled trials demonstrated that mortality was increased by 'early goal-directed therapy' interventions that increased fluid resuscitation (R.R. 1.26, 95% C.I. 1.00⁻1.58, = 0.045; ² 53%). The third observational cohort study demonstrated improved survival after implementation of protocolised management for sepsis (mortality 33.0% vs. 45.7%, = 0.005). No study incorporated standardised protocols for empirical antibiotic administration. High rates of pneumonia and mycobacteraemia were reported. There has been little research into the early recognition and management of sepsis in sub-Saharan Africa. Interventional trials of early goal-directed therapy have, to date, increased mortality. There is an urgent need to develop effective strategies to improve outcomes for adults with sepsis in sub-Saharan Africa.
在撒哈拉以南非洲的成年人中，脓毒症是发病率和死亡率的常见原因。有文献记载，标准化的管理路径可以提高高资源环境中脓毒症成年人的生存率。我们的目的是评估撒哈拉以南非洲资源匮乏地区早期脓毒症干预措施（识别、经验性抗生素和复苏）的现有证据基础。我们搜索了 MEDLINE、EMBASE 和 CINHAL Plus 数据库，使用基于协议的搜索策略，确定了撒哈拉以南非洲地区早期识别和管理脓毒症的干预性研究：成年人、方案化护理路径和撒哈拉以南非洲。我们共确定了 725 篇出版物，其中 3 篇符合最终选择标准。两项随机对照试验的荟萃分析表明，增加液体复苏的“早期目标导向治疗”干预措施增加了死亡率（RR 1.26，95%CI 1.00-1.58， = 0.045；² 53%）。第三项观察性队列研究表明，实施脓毒症方案化管理后，生存率有所提高（死亡率 33.0%对 45.7%， = 0.005）。没有研究纳入经验性抗生素使用的标准化方案。报告了较高的肺炎和分枝杆菌血症发生率。撒哈拉以南非洲地区对脓毒症的早期识别和管理的研究很少。到目前为止，早期目标导向治疗的干预试验增加了死亡率。迫切需要制定有效的策略来改善撒哈拉以南非洲地区成年人脓毒症的结局。
