Abstract
Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome. To describe differences between resource-poor andresource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU. Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources. Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.
Highlights
In many low- and middle-income countries (LMICs), the relative importance of curative care to improve health becomes more important with improved public health services, such as sanitation and immunization
Disease burden While detailed information has been reported on the epidemiology and outcome of sepsis in high-income countries (HICs) [5, 6], systematically collected epidemiological data from LMICs are limited [7, 8], even though about 80% of the global mortality caused by infections occur in these countries [9]
It will be important that education on sepsis management does not focus only on intensive care unit (ICU) physicians, but includes medical schools, nursing schools and the training of other healthcare workers, as many sepsis patients in LMICs receive treatment outside an ICU
Summary
In many low- and middle-income countries (LMICs), the relative importance of curative care to improve health becomes more important with improved public health services, such as sanitation and immunization. This includes care for severe sepsis, a major reason for intensive care unit (ICU) admission in LMICs. This includes care for severe sepsis, a major reason for intensive care unit (ICU) admission in LMICs These patients will currently often be treated in general wards, but basic intensive care facilities are becoming increasingly available.
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