Bonnewell John P, Crump John A, Egger Joseph R, Sakita Francis M, Hertz Julian T, Kilonzo Kajiru G, Maro Venance P, Rubach Matthew P
Division of Laboratory Medicine, Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Division of Infectious Diseases, Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
Open Forum Infect Dis. 2024 Dec 14;12(1):ofae722. doi: 10.1093/ofid/ofae722. eCollection 2025 Jan.
Despite a high burden of sepsis in Sub-Saharan Africa, clinical data for adolescent and adult sepsis in this setting are limited. We sought to describe clinical characteristics, management, and outcomes in adolescents and adults with sepsis in northern Tanzania. We also assessed for clinical associations with in-hospital mortality.
We conducted a prospective observational cohort study at Kilimanjaro Christian Medical Centre in Moshi, Tanzania, 2019-2020. Data were collected on demographics, clinical characteristics, and management primarily from hours 0-6 after arrival at the emergency department. We calculated bivariable risk ratios (RRs) for associations between demographic and clinical factors and in-hospital death. A multivariable-adjusted analysis was performed for associations between antimicrobial and intravenous fluid administration and in-hospital death.
Of 86 participants with sepsis, 25 (29.1%) died in the hospital. Baseline characteristics associated with in-hospital mortality included inability to drink unassisted (RR, 3.15; 95% CI, 1.58-6.30), altered mentation (RR, 3.94; 95% CI, 2.12-7.33), quick Sequential Organ Failure Assessment (qSOFA) score ≥2 (RR, 2.86; 95% CI, 1.42-5.72), and Universal Vital Assessment score ≥5 (RR, 6.33; 95% CI, 2.36-17.02). Twenty-nine (33.7%) received an antimicrobial by hour 6. HIV antibody testing was performed for 4 (4.7%) participants by hour 6. On multivariable analysis, neither antimicrobial administration nor intravenous fluids >1L by hour 6 was associated with in-hospital mortality.
Sepsis at our center in northern Tanzania carried a high risk of in-hospital mortality. Further research is needed to establish the highest-yield interventions suited to the unique characteristics of sepsis in Sub-Saharan Africa.
尽管撒哈拉以南非洲地区脓毒症负担沉重，但该地区青少年和成人脓毒症的临床数据有限。我们试图描述坦桑尼亚北部青少年和成人脓毒症的临床特征、治疗及结局。我们还评估了与院内死亡相关的临床因素。
2019年至2020年，我们在坦桑尼亚莫希的乞力马扎罗基督教医疗中心开展了一项前瞻性观察性队列研究。主要在抵达急诊科后的0至6小时收集人口统计学、临床特征及治疗方面的数据。我们计算了人口统计学和临床因素与院内死亡之间关联的双变量风险比（RR）。对抗菌药物使用和静脉输液与院内死亡之间的关联进行了多变量调整分析。
86名脓毒症参与者中，25人（29.1%）在医院死亡。与院内死亡相关的基线特征包括无法自主饮水（RR，3.15；95%CI，1.58 - 6.30）、意识改变（RR，3.94；95%CI，2.12 - 7.33）、快速序贯器官衰竭评估（qSOFA）评分≥2（RR，2.86；95%CI，1.42 - 5.72）以及通用生命评估评分≥5（RR，6.33；95%CI，2.36 - 17.02）。29人（33.7%）在6小时内接受了抗菌药物治疗。4名（4.7%）参与者在6小时内进行了HIV抗体检测。多变量分析显示，6小时内使用抗菌药物及静脉输液量>1L均与院内死亡无关。
我们在坦桑尼亚北部中心的脓毒症患者有较高的院内死亡风险。需要进一步研究以确定适合撒哈拉以南非洲地区脓毒症独特特征的最高效干预措施。
