Community-acquired sepsis in the medical intensive care unit: An experience from a lower-middle-income country

J Pak Med Assoc. 2024 Nov;74(11):1942-1947. doi: 10.47391/JPMA.11323.

Abstract

Objectives: To determine microbiological pathogens and in-hospital mortality in patients admitted with communityacquired sepsis to the intensive care unit in a tertiary-care setting in a low- and middle-income country.

Methods: The retrospective, observational study was conducted at the medical intensive care unit of a large tertiary care hospital in Karachi, and comprised data from January 1 to December 31, 2019 of patients with community-acquired sepsis who were assessed using the Sepsis-3 criteria. Data was compared between survivors and non-survivors, and independent factors associated with in-hospital mortality were identified. Data was analysed using SPSS 23.

Results: Of the 135 patients with mean age 49.8±18.0 years, 91(67.4%) were males and 44(32.6%) were females. The most common primary site of infection was the respiratory tract 63(46.7%). Multi-drug-resistant organisms were isolated in 39 (28.9%) patients. In-hospital mortality was noted in 52(38.5%) cases, while there were 83(61.5%) survivors. Serum levels of lactate and bicarbonate as well as urine output, fungal pathogens, septic shock and sequential organ failure assessment score were significantly associated with mortality (p<0.05).

Conclusions: Clinical and microbiological spectrum of community-acquired sepsis in a low- and middle-income country was found to be different from other regions of the world. Clinicians should keep these differences in mind while managing these critically ill patients.

Keywords: Sepsis, Septic shock, Critical care, Drug resistance, Fungi..

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Community-Acquired Infections* / epidemiology
  • Community-Acquired Infections* / microbiology
  • Community-Acquired Infections* / mortality
  • Developing Countries
  • Female
  • Hospital Mortality*
  • Humans
  • Intensive Care Units* / statistics & numerical data
  • Male
  • Middle Aged
  • Organ Dysfunction Scores
  • Pakistan / epidemiology
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / microbiology
  • Respiratory Tract Infections / mortality
  • Retrospective Studies
  • Sepsis* / epidemiology
  • Sepsis* / microbiology
  • Sepsis* / mortality
  • Shock, Septic / microbiology
  • Shock, Septic / mortality
  • Tertiary Care Centers