TY - JOUR
T1 - Causes and outcomes of sepsis in southeast Asia
T2 - a multinational multicentre cross-sectional study
AU - Southeast Asia Infectious Disease Clinical Research Network
AU - Sudarmono, Pratiwi
AU - Aman, Abu Tholib
AU - Arif, Mansyur
AU - Syarif, Armaji Kamaludi
AU - Kosasih, Herman
AU - Karyana, Muhammad
AU - Chotpitayasunondh, Tawee
AU - Vandepitte, Warunee Punpanich
AU - Boonyasiri, Adiratha
AU - Lapphra, Keswadee
AU - Chokephaibulkit, Kulkanya
AU - Rattanaumpawan, Pinyo
AU - Thamlikitkul, Visanu
AU - Laongnualpanich, Achara
AU - Teparrakkul, Prapit
AU - Srisamang, Pramot
AU - Phuc, Phan Huu
AU - Hai, Le Thanh
AU - Van Kinh, Nguyen
AU - Phu, Bui Duc
AU - Hung, Nguyen Thanh
AU - Thuong, Tang Chi
AU - Tuan, Ha Manh
AU - Yen, Lam Minh
AU - Chau, Nguyen Van Vinh
AU - Limmathurotsakul, Direk
AU - Thaipadungpanit, Janjira
AU - Blacksell, Stuart
AU - Day, Nicholas
AU - Thwaites, Guy
AU - Wertheim, Heiman
AU - Van Tan, Le
AU - Rahman, Motiur
AU - van Doorn, H. Rogier
AU - Lau, Chuen Yen
N1 - Publisher Copyright:
© 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background Improved understanding of pathogens that cause sepsis would aid management and antimicrobial selection. In this study, we aimed to identify the causative pathogens of sepsis in southeast Asia. Methods In this multinational multicentre cross-sectional study of community-acquired sepsis and severe sepsis, we prospectively recruited children (age ≥30 days and <18 years) and adults (age ≥18 years) at 13 public hospitals in Indonesia (n=3), Thailand (n=4), and Vietnam (n=6). Hospitalised patients with suspected or documented community-acquired infection, with at least three diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 h of admission were enrolled. Blood from every patient, and nasopharyngeal swab, urine, stool, and cerebrospinal fluid, if indicated, were collected for reference diagnostic tests to identify causative pathogens. We report causative pathogens of sepsis and 28-day mortality. We also estimate mortality associated with enrolment with severe sepsis. This study was registered with ClinicalTrials.gov, number NCT02157259. Findings From Dec 16, 2013, to Dec 14, 2015, 4736 patients were screened and 1578 patients (763 children and 815 adults) were enrolled. Dengue viruses (n=122 [8%]), Leptospira spp (n=95 [6%]), rickettsial pathogens (n=96 [6%]), Escherichia coli (n=76 [5%]), and influenza viruses (n=65 [4%]) were commonly identified in both age groups; whereas Plasmodium spp (n=12 [1%]) and Salmonella enterica serovar Typhi (n=3 [0·2%]) were rarely observed. Emerging pathogens identified included hantaviruses (n=28 [2%]), non-typhoidal Salmonella spp (n=21 [1%]), Streptococcus suis (n=18 [1%]), Acinetobacter spp (n=12 [1%]), and Burkholderia pseudomallei (n=5 [<1%]). 28-day mortality occurred in 14 (2%) of 731 children with known statuses and 108 (13%) of 804 adults. Severe sepsis was identified on enrolment in 194 (28%) of 731 children and 546 (68%) of 804 adults, and was associated with increased mortality (adjusted odds ratio 5·3, 95% CI 2·7–10·4; p<0·001). Interpretation Sepsis in southeast Asia is caused by a wide range of known and emerging pathogens, and is associated with substantial mortality. Funding National Cancer Institute, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA, and Wellcome Trust, UK.
AB - Background Improved understanding of pathogens that cause sepsis would aid management and antimicrobial selection. In this study, we aimed to identify the causative pathogens of sepsis in southeast Asia. Methods In this multinational multicentre cross-sectional study of community-acquired sepsis and severe sepsis, we prospectively recruited children (age ≥30 days and <18 years) and adults (age ≥18 years) at 13 public hospitals in Indonesia (n=3), Thailand (n=4), and Vietnam (n=6). Hospitalised patients with suspected or documented community-acquired infection, with at least three diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 h of admission were enrolled. Blood from every patient, and nasopharyngeal swab, urine, stool, and cerebrospinal fluid, if indicated, were collected for reference diagnostic tests to identify causative pathogens. We report causative pathogens of sepsis and 28-day mortality. We also estimate mortality associated with enrolment with severe sepsis. This study was registered with ClinicalTrials.gov, number NCT02157259. Findings From Dec 16, 2013, to Dec 14, 2015, 4736 patients were screened and 1578 patients (763 children and 815 adults) were enrolled. Dengue viruses (n=122 [8%]), Leptospira spp (n=95 [6%]), rickettsial pathogens (n=96 [6%]), Escherichia coli (n=76 [5%]), and influenza viruses (n=65 [4%]) were commonly identified in both age groups; whereas Plasmodium spp (n=12 [1%]) and Salmonella enterica serovar Typhi (n=3 [0·2%]) were rarely observed. Emerging pathogens identified included hantaviruses (n=28 [2%]), non-typhoidal Salmonella spp (n=21 [1%]), Streptococcus suis (n=18 [1%]), Acinetobacter spp (n=12 [1%]), and Burkholderia pseudomallei (n=5 [<1%]). 28-day mortality occurred in 14 (2%) of 731 children with known statuses and 108 (13%) of 804 adults. Severe sepsis was identified on enrolment in 194 (28%) of 731 children and 546 (68%) of 804 adults, and was associated with increased mortality (adjusted odds ratio 5·3, 95% CI 2·7–10·4; p<0·001). Interpretation Sepsis in southeast Asia is caused by a wide range of known and emerging pathogens, and is associated with substantial mortality. Funding National Cancer Institute, National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA, and Wellcome Trust, UK.
UR - http://www.scopus.com/inward/record.url?scp=85009360461&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(17)30007-4
DO - 10.1016/S2214-109X(17)30007-4
M3 - Article
C2 - 28104185
AN - SCOPUS:85009360461
SN - 2214-109X
VL - 5
SP - e157-e167
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 2
ER -