Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Surg Infect (Larchmt). 2020 Sep;21(7):571-578. doi: 10.1089/sur.2020.047. Epub 2020 May 13.
The greatest burden of sepsis- and septic shock-related morbidity and mortality is in low- and middle-income countries (LMICs). Accurate tracking of incidence and outcomes of patients in LMICs with sepsis has been limited by changing definitions, lack of diagnosis coding and health records, and deficits in personnel. Improving sepsis care in LMICs requires studying outcomes prospectively so that setting appropriate definitions, scoring systems, and treatment guidelines can be created. Our goal is to review the burden of sepsis and septic shock in LMICs, the evolution and applicability of definitions to LMICs, and management. The literature was searched through PubMed using a Boolean approach and the following terms: sepsis, septic shock, low- and middle-income countries. Articles were read by the authors and relevant information was abstracted and included with citations to create a narrative review. The estimated worldwide incidence of sepsis admissions is 31.5 million cases per year leading to 5.3 million deaths. The World Health Organization (WHO) has urged LMICs to establish sepsis prevalence and outcomes. Most authors and societies involved in creating sepsis and septic shock definitions have been from high-income countries (HICs). Applicability of sepsis definitions in LMICs is uncertain. Quick-Sequential Organ Failure Assessment (qSOFA) and universal vital assessment (UVA) are useful screening and triage tools in LMICs because they can be done at the bedside. The key tenets of management of sepsis and septic shock in LMICs include early fluid resuscitation and antibiotic therapy coupled with source control when there is a surgical process. Surgical causes of sepsis should be identified rapidly. Scaling up surgical capacity in LMICs is an important step to improve source control of sepsis. Management guidelines specific to LMICs for sepsis and septic shock need to be refined further and studied prospectively. Improving access to surgery will improve outcomes of surgical cases of sepsis.
脓毒症和脓毒性休克相关发病率和死亡率的最大负担在中低收入国家（LMICs）。由于定义不断变化、缺乏诊断编码和健康记录以及人员短缺，因此准确跟踪 LMICs 中脓毒症患者的发病率和结果受到限制。要改善 LMICs 中的脓毒症护理，需要前瞻性地研究结果，以便制定适当的定义、评分系统和治疗指南。我们的目标是回顾 LMICs 中脓毒症和脓毒性休克的负担、定义在 LMICs 中的演变和适用性，以及管理。通过使用布尔方法和以下术语在 PubMed 上搜索文献：脓毒症、脓毒性休克、中低收入国家。作者阅读了文章，并摘录了相关信息并引用，以创建叙述性评论。据估计，全球脓毒症入院率为每年 3150 万例，导致 530 万人死亡。世界卫生组织（WHO）敦促 LMICs 建立脓毒症的流行率和结果。参与制定脓毒症和脓毒性休克定义的大多数作者和协会都来自高收入国家（HICs）。脓毒症定义在 LMICs 中的适用性尚不确定。快速序贯器官衰竭评估（qSOFA）和普遍生命评估（UVA）是 LMICs 中有用的筛选和分诊工具，因为它们可以在床边进行。在 LMICs 中管理脓毒症和脓毒性休克的关键原则包括早期液体复苏和抗生素治疗，以及在存在手术过程时进行源控制。应迅速确定脓毒症的手术原因。扩大 LMICs 的手术能力是改善脓毒症源控制的重要步骤。需要进一步细化针对 LMICs 的脓毒症和脓毒性休克管理指南，并进行前瞻性研究。改善手术机会将改善脓毒症手术病例的结果。
