The Epidemiology, Therapeutic Patterns, Outcome, and Challenges in Managing Septic Shock in a Sub-Saharan African Intensive Care Unit: A CrossSectional Study

Junette Arlette Metogo Mbengono,Yves Bertrand Nzouango,Glwadys Ngono Ateba,Stephane Kona,Aminata Colibaly,Joël Noutakdie Tochie,Cassandra Tocko,Jacqueline Ze Minkande,Ferdinand Ndom Ntock,Gérard Beyiha

doi:10.15171/hpr.2019.24

Junette Arlette Metogo Mbengono, Yves Bertrand Nzouango + Show 8 more

Open Access

https://doi.org/10.15171/hpr.2019.24

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Abstract

Background: Septic shock (SS) is a health priority in sub-Saharan Africa. However, there is a dearth of data in this regard. Objective: This study aimed to determine the epidemiology, therapeutic patterns, outcome, and challenges in managing SS in a tertiary intensive care unit (ICU) of sub-Saharan Africa. Methods: The hospital files of 36 consecutive patients admitted to the ICU of the Douala General Hospital (DGH), Cameroon over the year 2018 were reviewed for SS. SS was diagnosed based on Sepsis-3 definition. Demographic and clinical characteristics, treatment details, and outcomes of patients with SS were reviewed. Data was analyzed using the chi-square or Fisher exact tests and Bonferroni correction. Results: SS accounted for 36 (9.4%) ICU admissions. The majority of patients were males (63.9%). The most common site of infection was the lungs. The mean age, average mean arterial pressure (MAP), and mean sequential organ failure assessment (SOFA) score of patients were 52.9±25.2 years, 52±18 mm Hg, and 9.2 ±2.3, respectively. Noradrenaline was the sole vasopressor used. Therapeutic challenges included the inability to have a specific antibiogram before a mean duration of 7 days. The mortality rate was 39% and associated with age ≤1 year, MAP ≤ 65 mm Hg, Glasgow Coma Score (GCS) ≤8, and mechanical ventilation, which were not attenuated after Bonferroni correction. Conclusion: SS is a frequent cause of ICU admission and is associated with a high mortality rate. SS mortality-related factors can be screened during SS management for more aggressive ICU management geared at preventing death.

Highlights

Septic shock (SS) is a health priority in sub-Saharan Africa
Therapeutic challenges included the inability to have a specific antibiogram before a mean duration of 7 days
The current findings suggest that SS accounts for about one out of every 10 admissions and one out of every 3 deaths among patients admitted for SS in the intensive care unit (ICU) in this study

Summary

Introduction

Septic shock (SS) is a health priority in sub-Saharan Africa. there is a dearth of data in this regard. Sepsis and septic shock (SS) are globally recognized by the WHO as health priorities.[1] Patients with SS have an inadequate blood supply perfused to noble organs, resulting in coma, strokes, myocardial infarction, acute kidney injury, or multi-organ dysfunction and death if resuscitation is not performed in a timely manner.[2,3] Survivors of SS are at an increased risk of reduced quality of life due to long-term physical, cognitive, and psychological dysfunction,[4,5] as well as death within a year following hospital discharge.[6] Worldwide, the incidence of sepsis is estimated to be 188 to 270 per 100 000 adults[7,8] and 19.4 million children are hospitalized for sepsis each year.[8] SS accounts for a mortality rate varying between 17.1% and 60.1%8–12 and 5.3 million child deaths per annum.[8] Currently, the debate on the most effective pharmacological management for SS is ongoing. About 70%–80% of sepsis cases are community-acquired, making

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