Epidemiology, Management, and Outcomes of Patients Hospitalized With Community-Acquired Infection in a Resource-Limited Setting in Southeast Asia: A Prospective Observational Study - Report - MDSpire
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Epidemiology, Management, and Outcomes of Patients Hospitalized With Community-Acquired Infection in a Resource-Limited Setting in Southeast Asia: A Prospective Observational Study
Epidemiology, Management, and Outcomes of Community-Acquired Infections in Rural Southeast Asia
Overview
A prospective study of 940 adults hospitalized with community-acquired infections in northeast Thailand found that 66% met sepsis criteria, with a 20% 28-day mortality among septic patients. Sepsis-associated acute kidney injury (SA-AKI) was independently linked to increased mortality, highlighting critical illness outside intensive care units and the predominance of gram-negative pathogens.
Background
Sepsis disproportionately affects low- and middle-income countries, with Southeast Asia experiencing high morbidity due to diverse tropical pathogens. Traditional sepsis studies focus on ICU patients, but many in resource-limited settings receive care outside ICUs. There is limited data on community-acquired infections and sepsis in rural Southeast Asia, necessitating studies to inform context-specific management strategies. This study prospectively enrolled adults hospitalized with suspected or confirmed infection to assess epidemiology, treatment, and outcomes.
Data Highlights
Parameter
Value
Patients screened
1445
Patients enrolled
940
Median age (years)
60
Diabetes mellitus prevalence
42%
Patients meeting sepsis criteria
66%
Blood cultures performed on admission
>95%
Broad-spectrum antibiotics on admission
>95%
Lactate measurement in sepsis patients
43%
Respiratory failure on ward admission (sepsis patients)
33%
Shock on ward admission (sepsis patients)
21%
Melioidosis cases
8%
Leptospirosis cases
4%
Gram-negative bacteremia
81%
28-day mortality in sepsis patients
20%
Adjusted odds ratio for mortality with SA-AKI
2.07 (95% CI, 1.30–3.29; P = .002)
Key Findings
Two-thirds of hospitalized patients with community-acquired infection met sepsis criteria.
Sepsis-associated acute kidney injury (SA-AKI) on admission doubled the risk of 28-day mortality.
Respiratory failure and shock were common critical illnesses outside the ICU on admission among sepsis patients.
Gram-negative organisms accounted for the majority (81%) of bacteremia cases.
Tropical infections such as melioidosis (8%) and leptospirosis (4%) were notable etiologies.
Broad-spectrum antibiotics and blood cultures were widely used (>95%) even in patients without sepsis.
Clinical Implications
Clinicians in resource-limited Southeast Asian settings should recognize the high prevalence of sepsis and associated organ dysfunction outside ICUs, emphasizing early identification and management of SA-AKI to improve outcomes. Empiric broad-spectrum antibiotic coverage targeting gram-negative and tropical pathogens is warranted. Enhanced access to diagnostic tools like lactate measurement may aid risk stratification and guide therapy.
Conclusion
Sepsis is common and associated with significant morbidity and mortality among patients hospitalized with community-acquired infections in rural Southeast Asia. Identification of modifiable risk factors such as SA-AKI offers opportunities to optimize initial management and improve survival in resource-constrained environments.
References
Global Burden of Sepsis Study 2020 -- Sepsis mortality in LMICs
Regional Tropical Infection Studies 2021 -- Etiologies of sepsis in Southeast Asia
Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) 2016
KDIGO Clinical Practice Guideline for Acute Kidney Injury 2012
