title: Feasibility of modified surviving sepsis campaign guidelines in a resource-restricted setting based on a cohort study of severe S. aureus sepsis [corrected].
abstract: BACKGROUND
  The Surviving Sepsis Campaign (SSC) guidelines describe best practice for the management of severe sepsis and septic shock in developed countries, but most deaths from sepsis occur where healthcare is not sufficiently resourced to implement them. Our objective was to define the feasibility and basis for modified guidelines in a resource-restricted setting.
  
  
  RESULTS
  We undertook a detailed assessment of sepsis management in a prospective cohort of patients with severe sepsis caused by a single pathogen in a 1,100-bed hospital in lower-middle income Thailand. We compared their management with the SSC guidelines to identify care bundles based on existing capabilities or additional activities that could be undertaken at zero or low cost. We identified 72 patients with severe sepsis or septic shock associated with S. aureus bacteraemia, 38 (53%) of who died within 28 days. One third of patients were treated in intensive care units (ICUs). Numerous interventions described by the SSC guidelines fell within existing capabilities, but their implementation was highly variable. Care available to patients on general wards covered the fundamental principles of sepsis management, including non-invasive patient monitoring, antimicrobial administration and intravenous fluid resuscitation. We described two additive care bundles, one for general wards and the second for ICUs, that if consistently performed would be predicted to improve outcome from severe sepsis.
  
  
  CONCLUSIONS
  It is feasible to implement modified sepsis guidelines that are scaled to resource availability, and that could save lives prior to the publication of international guidelines for developing countries.
authors.affiliation: Department of Medicine, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand.
authors.forename: Weera
authors.initials: W
authors.lastname: Mahavanakul
authors.forename: Emma K
authors.initials: EK
authors.lastname: Nickerson
authors.forename: Pramot
authors.initials: P
authors.lastname: Srisomang
authors.forename: Prapit
authors.initials: P
authors.lastname: Teparrukkul
authors.forename: Pichet
authors.initials: P
authors.lastname: Lorvinitnun
authors.forename: Mingkwan
authors.initials: M
authors.lastname: Wongyingsinn
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Chierakul
authors.forename: Maliwan
authors.initials: M
authors.lastname: Hongsuwan
authors.forename: T Eoin
authors.initials: TE
authors.lastname: West
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Day
authors.forename: Direk
authors.initials: D
authors.lastname: Limmathurotsakul
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
mesh_terms: D000328:Adult; D002648:Child; D015331:Cohort Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D017408:Guidelines as Topic; D006293:Health Promotion / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D012151:Resuscitation; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology / Q000628:therapy; D013211:Staphylococcus aureus / Q000502:physiology*; D013785:Thailand / Q000453:epidemiology