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Aetiology and outcomes of sepsis in adults in sub-Saharan Africa: a systematic review and meta-analysis.

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Lewis, Joseph, Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405 and Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611 (2019) 'Aetiology and outcomes of sepsis in adults in sub-Saharan Africa: a systematic review and meta-analysis.'. Critical Care, Vol 23, Issue 1, p. 212.

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Abstract

BACKGROUND
Aetiology and outcomes of sepsis in sub-Saharan Africa (sSA) are poorly described; we performed a systematic review and meta-analysis to summarise the available data.
METHODS
Systematic searches of PubMed and Scopus were undertaken to identify prospective studies recruiting adults (> 13 years) with community-acquired sepsis in sSA post-2000. Random effects meta-analysis of in-hospital and 30-day mortality was undertaken and available aetiology data also summarised by random effects meta-analysis.
RESULTS
Fifteen studies of 2800 participants were identified. Inclusion criteria were heterogeneous. The majority of patients were HIV-infected, and Mycobacterium tuberculosis was the most common cause of blood stream infection where sought. Pooled in-hospital mortality for Sepsis-2-defined sepsis and severe sepsis was 19% (95% CI 12-29%) and 39% (95% CI 30-47%) respectively, and sepsis mortality was associated with the proportion of HIV-infected participants. Mortality and morbidity data beyond 30 days were absent.
CONCLUSIONS
Sepsis in sSA is dominated by HIV and tuberculosis, with poor outcomes. Optimal antimicrobial strategies, including the role of tuberculosis treatment, are unclear. Long-term outcome data are lacking. Standardised sepsis diagnostic criteria that are easily applied in low-resource settings are needed to establish an evidence base for sepsis management in sSA.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 240 Bacteremia. Sepsis. Toxemias
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s13054-019-2501-y
Depositing User: Stacy Murtagh
Date Deposited: 18 Jun 2019 10:11
Last Modified: 20 Jun 2019 09:30
URI: https://archive.lstmed.ac.uk/id/eprint/11061

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