Early Management of Community-Acquired Sepsis in a Regional Thai Referral Hospital: a Prospective Observational Study

Abstract

Purpose: The epidemiology and management of sepsis is poorly characterized in low- and middle-income countries. Methods: We performed a prospective observational cohort study of adults with community-acquired sepsis in a 1,420-bed regional referral hospital in northeast Thailand. Sepsis was defined as suspected infection plus organ dysfunction. Results: Between March 2013 and February 2014, 932 patients with sepsis were enrolled. Five hundred twelve (55%) were male and the mean age was 54 years. Eighty three percent of patients were transferred from other hospitals. Eighty four percent of patients were first evaluated in the Emergency Department, where median length of stay was 25 minutes. In the first day after presentation to the study hospital, the majority had blood cultures ordered (80%) and received antibiotics (84%). Most patients were admitted to the general medical wards; 15% were admitted to the intensive care unit (ICU) within the first hospital day. Patients admitted to the ICU had similar demographics and pre-existing co-morbidities but were more critically ill, and were and more likely to receive all measured sepsis management interventions. In-hospital mortality was 9% (87/932) and 28-day mortality was 22% (203/932). The 28-day mortality was significantly higher for patients admitted to the ICU on the first day (45% [63/139] vs. 18% [140/793], p<0.001). Conclusions: Sepsis in a regional referral hospital in rural Thailand, where some resources are limited, is commonly managed on general medical wards despite high rates of respiratory failure and shock. Twenty-eight-day mortality is comparable to some high-resource settings.