An audit of diagnosis and treatment of sepsis in north-central Nigeria.

BACKGROUND: We audited the diagnosis and antibiotic therapy of patients admitted with sepsis in a resource-limited Nigerian hospital setting in order to improve the quality of sepsis care.

METHOD: We conducted a retrospective analysis of the records of medical patients admitted for sepsis at the Jos University Teaching Hospital between September 2011 and August 2012. Data analysis included age, sex, appropriateness of sepsis diagnosis/severity, comorbidities, utility/yield of sample cultures, antibiotic therapy, duration of hospital stay and treatment outcome.

RESULT: Only 94 out of 142 cases (66.2%) were judged to meet the diagnostic criteria for sepsis. Out of the 94 patients, 77 (82%) were appropriately classified for sepsis severity. Nineteen patients (20%) met criteria for severe sepsis/septic shock. The commonest comorbidity was HIV/AIDS (57.3%). All the patients received empirical antibiotic therapy but in 23 cases (24.5%), the empirical prescriptions were judged inappropriate and none was administered within one hour of diagnosis. Blood cultures were available to guide definitive antibiotic therapy in only 12.5% of cases. The median (range) duration of hospital stay was 12 (1-70) days while the in-hospital mortality rate was 53%.

CONCLUSION: The management of sepsis was suboptimal in our setting and mortality was high. We recommend adoption of standard sepsis guidelines to ensure optimal management and improved outcome.