title: Presentation, management, and outcomes of sepsis in adults and children admitted to a rural Ugandan hospital: A prospective observational cohort study.
abstract: OBJECTIVE
  Limited data are available on sepsis in low-resource settings, particularly outside of urban referral centers. We conducted a prospective observational single-center cohort study in May 2013 to assess the presentation, management and outcomes of adult and pediatric patients admitted with sepsis to a community hospital in rural Uganda.
  
  
  METHODS
  We consecutively screened all patients admitted to medical wards who met sepsis criteria. We evaluated eligible patients within 24 hours of presentation and 24-48 hours after admission, and followed them until hospital discharge. In addition to chart review, mental status evaluation, peripheral capillary oxygen saturation, and point-of-care venous whole blood lactate and glucose testing were performed.
  
  
  RESULTS
  Of 56 eligible patients, we analyzed data on 51 (20 adults and 31 children). Median age was 8 years (IQR 2-23 years). Sepsis accounted for a quarter of all adult and pediatric medical ward admissions during the study period. HIV prevalence among adults was 30%. On enrollment, over half of patients had elevated point-of-care whole blood lactate, few were hypoglycemic or had altered mental status, and one third were hypoxic. Over 80% of patients received at least one antibiotic, all severely hypoxic patients received supplemental oxygen, and half of patients with elevated lactate received fluid resuscitation. The most common causes of sepsis were malaria and pneumonia. In-hospital mortality was 3.9%.
  
  
  CONCLUSIONS
  This study highlights the importance of sepsis among adult and pediatric patients admitted to a rural Ugandan hospital and underscores the need for continued research on sepsis in low resource settings.
authors.affiliation: International Respiratory and Severe Illness Center, University of Washington, Seattle, Washington, United States of America.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America.
authors.forename: Kristina E
authors.identifier: http://orcid.org/0000-0002-6695-8401
authors.initials: KE
authors.lastname: Rudd
authors.affiliation: Department of Paediatrics and Child Health, Bwindi Community Hospital, Kanungu, Uganda.
authors.forename: Leonard K
authors.initials: LK
authors.lastname: Tutaryebwa
authors.affiliation: International Respiratory and Severe Illness Center, University of Washington, Seattle, Washington, United States of America.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America.
authors.forename: T Eoin
authors.initials: TE
authors.lastname: West
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005440:Fluid Therapy; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006780:Hospitals, Rural; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D010102:Oxygen Inhalation Therapy; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D012720:Severity of Illness Index; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001786:Blood Glucose; D019344:Lactic Acid