Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study

Abstract

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.

Conflict of interest statement

Conflict of interest

We declare that we have no conflicts of interest.

Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1. Study Flow Diagram

Figure 2. Distribution of clinical presentations and pathogens identified among 763 paediatric patients

Numbers are numbers of patients with each clinical presentation and of each pathogen identified. In some patients, there was more than one clinical presentation or more than one pathogen identified.

Figure 3. Distribution of clinical presentations and pathogens identified among 815 adult patients

Numbers are numbers of patients with each clinical presentation and of each pathogen identified. In some patients, there was more than one clinical presentation or more than one pathogen identified.

Figure 4. Overlap among pathogens identified in (A) 763 paediatric patients and (B) 815 adult patients

Figure 4. Overlap among pathogens identified in (A) 763 paediatric patients and (B) 815 adult patients