Sepsis is one of the most frequent reasons of attendance at health facilities. Little is known about sepsis etiologies in adults which urge clinicians to overprescribe antimicrobials. We investigated causes of adult sepsis in outpatient clinics in urban Tanzania.
Consecutive patients >18 years with temperature >38°C were recruited. Detailed medical history and clinical examination were done. Several rapid tests were performed, as well as blood cultures, serological and molecular analyses. Multiplex PCR was done in nasal swabs. Chest X-rays, urine and stool cultures were done according to WHO algorithms. Final diagnoses were based on pre-defined criteria.
390 patients were recruited between July 2013-May 2014. 31% were HIV infected. Causes of sepsis were: 42% acute respiratory infection (ARI), 11% malaria, 9% urinary tract infection, 7% typhoid, 7% other bacterial infections, 4% gastroenteritis, 3% Streptococcus tonsillitis, 1% Cryptococcus, 1% West Nile, 1% CMV, 1% EBV and 14% unknown. The causes of ARI were: 42% URTI (29% influenza), 26% TB, 20% radiological pneumonia, 9% Pneumocystis jiroveci, 2% COPD exacerbation. Other bacterial infections were: 12 occult bacteremia, 5 meningitis, 2 rickettsiosis, 1 leptospirosis. In summary, 35% had a bacterial, 3% a fungal, 8% a parasitic and 54% a viral infection. 15% of patients had severe sepsis and 6% died. Severe sepsis rate (25 vs 8%) and death rate (12 vs 3%) were significantly higher in HIV infected patients (p<0.001). SOFA score predicted subsequent death (AUC=0.80, 95% CI 0.70-0.91). A score cut-point of 2 had a sensitivity of 80% and specificity of 72% for predicting mortality.
In addition, between Jan-May 2014, 131 patients were diagnosed with dengue, accounting for 39% of all fevers during this outbreak (the relative distribution of other causes remaining the same).
These results show a wide variety in the causes of sepsis and call for implementation of antibiotic and antimalarial stewardship and guidelines to support clinicians and limit the emergence of antimicrobial resistant strains. They also highlight the need of systematic HIV and TB screening in febrile patients and the importance of surveillance of epidemic-prone diseases causing sepsis.
J. Samaka, None
T. Mlaganile, None
T. Kazimoto, None
A. Mamin, None
B. Genton, None
L. Kaiser, None
V. D'acremont, None