The Etiology And Outcome Of Adult Patients Presenting With Sepsis To The University Teaching Hospital, Lusaka, Zambia.

BACKGROUND: Sepsis accounts for a significant burden of morbidity and mortality.In developed world, it is implicated as the second leading cause of non-cardiac death. Mortality from sepsis is on the increase with a mortality rate of 33-61%. In spite of the high burden of sepsis in sub Saharan Africa, data regarding the etiology and outcome of septic patients is limited. We conducted a prospective cohort study to describe the etiology, characteristic and outcome of patients presenting with sepsis to the University Teaching Hospital in Lusaka, Zambia.

METHODS: Patients who met the inclusion criteria were enrolled into the study and after a thorough examination, bloods were drawn for full blood count, urea and electrolytes, liver function tests and for culture. Samples for culture were collected under aseptic techniques and cultured for aerobic organisms. Biochemical and bacteriological methods were used to identify the isolates and antibiotic sensitivity patterns were determined using agar diffusion methods. Patients were then followed up until they either demised or were discharge.

RESULTS: A total of 161 patients were enrolled of which 110(68%) were HIV positive and 23(14%) had unknown HIV status. Bacteremia was found in 39 (24%) with the most isolated organism being staphylococcus aureus. Mortality in our cohort of septic patients was determinedat 40%. Identified predictors for in patient mortality were low admission Glasgow coma scale[OR 11.2(CI 3.5-36.4)], positive blood culture[OR 2.38(CI 1.14-4.95)] and HIV status, those with unknown HIV status were more likely to die than those who were HIV negative[OR 8.38(CI2.36-29.7)].

CONCLUSION: Most of the septic patients presenting to UTH had advanced immunosuppression (WHO stage 3 and 4) and had a high mortality rate. Staphylococcus aureus and streptococcus pneumoniae were the highest isolates. Identified predictors for in patient mortality could be used to try and improve outcome in septic patients at UTH.