Recommendations for sepsis management in resource-limited settings

Abstract

Infection and sepsis are among the leading causes of death world wide.The annual burden of sepsis in high income countries is risng with mortality of 40 %. Despite these figures from industrialized countries, the largest part of the global sepsis burden occurs in middle- & low- income countries, 90% of the world wide deaths from pneumonia, meningitis or other infections occur in less developed countries (Adhikary etal., 2010). Around 70 % of global deaths in neonats & infants are attributable to sepsis, with the majority of cases occurring in Asia & Sub- Saharan Africa. A high incidence of bacterial, parasitic, & HIV infection combined with low hygienic standards & and vaccination rates, widespread malnutrition & lack of resources, explain the death proportionally high morbidity & mortality from sepsis in these countries (Black etal., 2010). In 2004 & 2008, the surviving sepsis campaign released guidelines for severe sepsis & septic shock management. Implementation of these guidelines together with timely administration of essential therapies (e.g. fluid resuscitation, antibiotics,& source control measures) improved management & outcome. Similar initiatives have been undertaken in children resulting in comparable improvements in outcome. Despite their benefits, the surviving sepsis campaign and American college of critical care medicine pediatric guidelines can not be implemented in most middle- or low- income countries due to lacking resources. This leaves those clinicians caring for the majority of sepsis patients worldwide without standardized and adoptable guidance for sepsis care (Brierley etal., 2009). The recommendations are specifically based on resources affordable & commonly available in middle & low income countries and systematically weigh the available scientific evidence for its applicability in resource limited settings. They are not meant to replace the surviving sepsis campaign or American college of critical care medicine pediatric guidelines, but can be considered if the later are impossible to implement due to resource constrains (Dellinger etal., 2008). The present recommendations for sepsis management in resource-limited settings have been endorsed by the European Society of Intensive Care Medicine, the World Federation of the Pediatric Intensive and Critical Care Societies, the Global Sepsis Alliance, the Federation of Austrian Societies of Intensive Care Medicine, the Ugandan Society of Intensive Care Medicine and the Mongolian Society of Anesthesiology and Intensive Care Medicine.