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Intensive Care Med. 2017 May;43(5):612-624. doi: 10.1007/s00134-017-4750-z. Epub 2017 Mar 27.

Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future.

Author information

1
Mahidol University, Bangkok, Thailand. marcus.j.schultz@gmail.com.
2
Department of Intensive Care, Academic Medical Center and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. marcus.j.schultz@gmail.com.
3
University College of London Hospital, London, UK.
4
Mahidol University, Bangkok, Thailand.
5
Department of Intensive Care, Academic Medical Center and University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
6
Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada.
7
Bharati Vidyapeeth Deemed University Medical College, Pune, India.
8
Mulago National Referral Hospital, Kampala, Uganda.
9
University of Maryland School of Medicine, Baltimore, MD, USA.
10
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
11
University of Pittsburgh, Pittsburgh, PA, USA.
12
Hospital Sirio-Libanes, Sa├Á Paulo, Brazil.
13
Karolinska Institute, Stockholm, Sweden.
14
California Pacific Medical Center, San Francisco, CA, USA.
15
Mayo Clinic, Jacksonville, FL, USA.
16
Stony Brook University Medical Center, Stony Brook, NY, USA.
17
University of Washington, Seattle, WA, USA.
18
British Columbia Children's Hospital, Vancouver, Canada.
19
All India Institute of Medical Science, Delhi, India.
20
St. James's University Hospital, Dublin, Ireland.
21
Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
22
Aga Khan University Hospital, Nairobi, Kenya.
23
Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa.
24
Ispat General Hospital, Sundargarh, Rourkela, Odisha, India.
25
Seattle Children's Hospital and University of Washington, Seattle, WA, USA.
26
Medical Intensive Care Unit, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
27
Oxford University Clinical Research Unit, Hospital for Tropical Diseases, District 5, Ho Chi Minh City, Vietnam.
28
Trung Vuong Hospital, Ho Chi Minh City, Vietnam.
29
National University Hospital, Singapore, Singapore.
30
Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
31
Nova Medical School, CEDOC, New University of Lisbon and Hospital de Sao Francisco Xavier , Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
32
Appolo Hospitals, Chennai, India.
33
Mzuzu Central Hospital, Mzuzu, Malawi.
34
Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.

Abstract

BACKGROUND:

Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome.

AIM:

To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU.

FINDINGS:

Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources.

CONCLUSIONS:

Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

KEYWORDS:

Critical care; Resource-limited settings; Sepsis management

PMID:
28349179
DOI:
10.1007/s00134-017-4750-z
[Indexed for MEDLINE]

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