Epidemiology, Acute Management, and Outcomes of Patients With Sepsis Presenting to a Referral Hospital in Western Kenya
Epidemiology, Acute Management, and Outcomes of Patients With Sepsis Presenting to a Referral Hospital in Western Kenya
Sepsis is a clinical syndrome representing deranged hemodynamics (such as tachycardia)
 secondary to severe infection. In high-income countries (HICs), early resuscitation of septic
 patients with protocol-driven therapy, including quantitative fluid administration guided by
 invasive monitoring, has resulted in improved outcomes for septic patients. Prevalence and
 mortality of sepsis are thought to be higher in sub-Saharan Africa (SSA) than in high-income
 countries; however, most hospitals in SSA lack the technology and resources necessary to
 implement the resuscitation protocols used in HICs and therefore, mortality from sepsis
 remains high. The World Health Organization (WHO) has recently disseminated an algorithm for
 resuscitation of septic patients in low resource settings. This algorithm is based on expert
 consensus only, and its efficacy has never been tested.

 This study will be conducted in the Casualty Department of Moi Teaching and Referral Hospital
 (MTRH) in Eldoret, Kenya.

 The purpose of this study is to describe the epidemiology of patients presenting with severe
 sepsis, to examine the microbiology causing severe sepsis, to describe current management and
 outcomes for severe sepsis, and to test the effect of implementation of the WHO resuscitation
 algorithm at MTRH.

 The study design is a prospective before and after clinical trial. In an initial
 observational phase, adult patients presenting to the MTRH Casualty Department with sepsis
 and severe sepsis (the latter of which will be defined by elevated lactate) will be enrolled
 into a prospective observational cohort. Demographic data, medical characteristics, and
 microbiological studies will be obtained, then the management and outcomes of these patients
 will be observed. In a second phase, patients with sepsis will continue to be enrolled into a
 prospective observational cohort, while patients with severe sepsis will be enrolled into an
 intervention group. Patients in the intervention group will be managed according to the WHO
 resuscitation algorithm. Specifically, the WHO algorithm involves fluid boluses guided by
 vital signs and physical exam findings, rapid and early administration of empiric
 antibiotics, and frequent patient monitoring. The outcomes of interest are achievement of
 lactate clearance, which is a correlate of tissue perfusion, as well as 24-hour, in-hospital,
 and 30-day mortality.
Inclusion Criteria:

 -  Presenting to MTRH Casualty Department for acute medical care

 -  Suspected infection, in the judgment of the managing clinician

 -  At least 2 of the following: axillary temperature >37.5°C or <35.5°C or core
 temperature >38.0°C or <36.0°C; heart rate >90 beats per minute; respiratory rate >20
 breaths per minute; or systolic blood pressure <100 mmHg

 Exclusion Criteria:

 -  Lack of basic language skills in either English or Kiswahili

 -  Pregnancy

 -  Congestive heart failure or valvular heart disease (as a known prior diagnosis or in
 the judgment of the managing clinician)

 -  Need for immediate surgery (within 6 hours) in the judgment of the managing clinician

 -  Inability to consent to study participation and lack of accompaniment by a family
 member or other surrogate who can provide consent