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Lewis, Joseph 
ORCID: https://orcid.org/0000-0002-3837-5188, Mphasa, Madlitso, Keyala, Lucy, Banda, Rachel, Smith, Emma, Duggan, Jackie, Brooks, Tim, Catton, Matthew, Mallewa, Jane, Katha, Grace, Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116, Faragher, Brian, Gordon, Melita A, Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611 and Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405
(2022)
'A Longitudinal, Observational Study of Etiology and Long-Term Outcomes of Sepsis in Malawi Revealing the Key Role of Disseminated Tuberculosis'. Clinical Infectious Diseases, Vol 74, Issue 10, pp. 1840-1849.
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Abstract
Background
Sepsis protocols in sub-Saharan Africa (sSA) are typically extrapolated from high-income settings, yet sepsis in sSA 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 outcome in Blantyre, Malawi to inform design of treatment strategies tailored to sSA.
Methods
We recruited 225 adults meeting a sepsis case-definition defined by fever and organ dysfunction, in an observational cohort study at a single tertiary centre. Aetiology was defined using culture, antigen detection, serology and PCR. Effect of treatments on 28-day outcomes were assessed by Bayesian logistic regression.
Results
143/213 (67%) of participants were HIV-infected. We identified a diagnosis in 145/225 (64%) participants: most commonly tuberculosis (34%) followed by invasive bacterial (17%) and arboviral infections (13%) and malaria (9%) Tuberculosis was associated with HIV infection whereas malaria and arboviruses with the absence of HIV infection. Antituberculous chemotherapy was associated with survival (aOR 28-day death 0.17 [95% CrI 0.05-0.49] for receipt of antituberculous therapy). Of those with confirmed aetiology, 83% received the broad-spectrum antibacterial ceftriaxone but it would be expected to be active in only 24%.
Conclusions
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 aetiology. Novel antimicrobial strategies for sepsis tailored to sSA – including consideration of empiric antitubercular therapy in the HIV-infected - should be developed and trialed.
| Item Type: | Article |
|---|---|
| Subjects: | WA Public Health > WA 20.5 Research (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 240 Bacteremia. Sepsis. Toxemias WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW) |
| Digital Object Identifer (DOI): | https://doi.org/10.1093/cid/ciab710 |
| Depositing User: | Stacy Murtagh |
| Date Deposited: | 06 Sep 2021 10:59 |
| Last Modified: | 29 Jun 2022 10:46 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/18830 |
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