A Longitudinal, Observational Study of Etiology and Long-Term Outcomes of Sepsis in Malawi Revealing the Key Role of Disseminated Tuberculosis.
A Longitudinal, Observational Study of Etiology and Long-Term Outcomes of Sepsis in Malawi Revealing the Key Role of Disseminated Tuberculosis.
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DOI：
10.1093/cid/ciab710
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发表时间：
2022-05-30
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撒哈拉以南非洲的脓毒症治疗方案通常是从高收入环境中推断出来的，但撒哈拉以南非洲的脓毒症可能是由不同的病原体引起的，可能需要新的治疗策略。缺乏指导这些战略的数据。我们的目的是确定原因和可改变的因素与败血症的结果在布兰太尔，马拉维，以通知设计的治疗策略，为撒哈拉以南非洲。我们招募了225名符合脓毒症病例定义（定义为发热和器官功能障碍）的成人，在一个三级中心进行了一项观察性队列研究。通过培养、抗原检测、血清学和聚合酶链反应确定病原学。使用贝叶斯逻辑回归评估治疗对28天结局的影响。213名参与者中有143名（67%）感染了人类免疫缺陷病毒（HIV）。我们在225名参与者中的145名（64%）中确定了诊断，最常见的是结核病（TB; 34%），其次是侵入性细菌感染（17%），虫媒病毒感染（13%）和疟疾（9%）。结核病与艾滋病毒感染有关，而疟疾和虫媒病毒与艾滋病毒感染无关。抗结核化疗与生存率相关（28天死亡的校正比值比为0.17;接受抗结核治疗的95%可信区间为0.05-0.49）。在已确认病因的患者中，83%接受了广谱抗菌药头孢曲松，但预计仅24%有效。马拉维布兰太尔的败血症是由一系列病原体引起的;大多数病原体对大多数患者接受的广谱抗菌药物不敏感。HIV状态是病因学的关键决定因素。应开发和试验针对撒哈拉以南非洲败血症的新型抗菌策略，包括考虑在艾滋病毒感染者中进行经验性抗结核治疗。我们描述了马拉维败血症的病因和长期结果，以告知急需的本地适应败血症协议。播散性结核占优势，接受抗结核化疗与生存率相关。出院后死亡率很高是由于感染人类免疫缺陷病毒者的晚期死亡。
Sepsis protocols in sub-Saharan Africa are typically extrapolated from high-income settings, yet sepsis in sub-Saharan Africa is likely caused by distinct pathogens and may require novel treatment strategies. Data to guide such strategies are lacking. We aimed to define causes and modifiable factors associated with sepsis outcomes in Blantyre, Malawi, in order to inform the design of treatment strategies tailored to sub-Saharan Africa. We recruited 225 adults who met a sepsis case definition defined by fever and organ dysfunction in an observational cohort study at a single tertiary center. Etiology was defined using culture, antigen detection, serology, and polymerase chain reaction. The effect of treatment on 28-day outcomes was assessed using Bayesian logistic regression. There were 143 of 213 (67%) participants living with human immunodeficiency virus (HIV). We identified a diagnosis in 145 of 225 (64%) participants, most commonly tuberculosis (TB; 34%) followed by invasive bacterial infections (17%), arboviral infections (13%), and malaria (9%). TB was associated with HIV infection, whereas malaria and arboviruses with the absence of HIV infection. Antituberculous chemotherapy was associated with survival (adjusted odds ratio for 28-day death, 0.17; 95% credible interval, 0.05–0.49 for receipt of antituberculous therapy). Of those with confirmed etiology, 83% received the broad-spectrum antibacterial ceftriaxone, but it would be expected to be active in only 24%. Sepsis in Blantyre, Malawi, is caused by a range of pathogens; the majority are not susceptible to the broad-spectrum antibacterials that most patients receive. HIV status is a key determinant of etiology. Novel antimicrobial strategies for sepsis tailored to sub-Saharan Africa, including consideration of empiric antituberculous therapy in individuals living with HIV, should be developed and trialed. We describe etiology and long-term outcomes of sepsis in Malawi in order to inform urgently needed locally adapted sepsis protocols. Disseminated tuberculosis dominates, and receipt of antituberculous chemotherapy is associated with survival. Significant post-discharge mortality is driven by late deaths in people living with human immunodeficiency virus.
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DOI：
10.1016/s0140-6736(18)31267-4
发表时间：
2018-07-28
期刊：
Lancet (London, England)
影响因子：
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作者：
Gupta-Wright A;Corbett EL;van Oosterhout JJ;Wilson D;Grint D;Alufandika-Moyo M;Peters JA;Chiume L;Flach C;Lawn SD;Fielding K
通讯作者：
Fielding K
增强流行病学观察研究的报告（Strobe）陈述：报告观察性研究的指南。
影响因子：
15.8
作者：
通讯作者：
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影响因子：
28.2
作者：
Waitt, Peter I.;Mukaka, Mavuto;Heyderman, Robert S.
通讯作者：
Heyderman, Robert S.
影响因子：
16.1
作者：
Grant, Alison D.;Charalambous, Salome;Fielding, Katherine L.
通讯作者：
Fielding, Katherine L.
影响因子：
158.5
作者：
Maitland, Kathryn;Kiguli, Sarah;Gibb, Diana M.
通讯作者：
Gibb, Diana M.