Stratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective

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dc.contributor.authorMatthew, J. Cummings
dc.contributor.authorBakamutumaho, Barnabas
dc.contributor.authorOwor, Nicholas
dc.contributor.authorKayiwa, John
dc.contributor.authorNamulondo, Joyce
dc.contributor.authorByaruhanga, Timothy
dc.contributor.authorMuwanga, Moses
dc.contributor.authorNsereko, Christopher
dc.contributor.authorBaldwin, Matthew R.
dc.contributor.authorLutwama, Julius J.
dc.contributor.authorMax, R. O’Donnell
dc.date.accessioned2025-03-09T11:28:28Z
dc.date.available2025-03-09T11:28:28Z
dc.date.issued2021
dc.description.abstractThe global burden of sepsis is concentrated in sub-Saharan Africa, where extensive pathogen diversity and limited laboratory capacity challenge targeted antimicrobial management of life-threatening infections. In this context, established and emerging rapid pathogen diagnostics may stratify sepsis patients into subgroups with prognostic and therapeutic relevance. In a prospective cohort of adults (age $18 years) hospitalized with suspected sepsis in Uganda, we stratified patients using rapid diagnostics for HIV, tuberculosis (TB), malaria, and influenza, and compared clinical characteristics and 30-day outcomes across these pathogen-driven subgroups. From April 2017 to August 2019, 301 adults were enrolled (median age, 32 years [interquartile range, 26–42 years]; female, n 5 178 [59%]). A total of 157 patients (53%) were HIV infected. Sixty-one patients (20%) tested positive for malaria, 52 (17%), for TB (including 49 of 157 [31%] HIV-infected patients), and 17 (6%), for influenza. Co-infection was identified in 33 (11%) patients. The frequency of multi-organ failure, including shock and acute respiratory failure, was greatest among patients with HIV-associated TB. Mortality at 30 days was 19% among patients with malaria, 40% among patients with HIV-associated TB, 32% among HIV-infected patients without microbiological evidence of TB, 6% among patients with influenza, and 11% among patients without a pathogen identified. Despite improvements in anti-retroviral delivery, the burden of sepsis in Uganda remains concentrated among young, HIV-infected adults, with a high incidence of severe HIV-associated TB. In parallel with improvements in acute-care capacity, use of rapid pathogen diagnostics may enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region. enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region.
dc.identifier.citationCummings, M. J., Bakamutumaho, B., Owor, N., Kayiwa, J., Namulondo, J., Byaruhanga, T., ... & O’Donnell, M. R. (2021). Stratifying sepsis in Uganda using rapid pathogen diagnostics and clinical data: a prospective cohort study. The American Journal of Tropical Medicine and Hygiene, 105(2), 517. doi:10.4269/ajtmh.21-0138
dc.identifier.other10.4269/ajtmh.21-0138
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/10080
dc.language.isoen
dc.publisherThe American Journal of Tropical Medicine and Hygiene
dc.titleStratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective
dc.typeArticle
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