Clinical Scorecard: Analysis of Epidemiology, Treatment Approaches, and Patient Outcomes for Community-Acquired Infections in Resource-Constrained Environments in Southeast Asia: A Prospective Observational Investigation

At a Glance

Key Highlights

• 66% of hospitalized patients with community-acquired infection met sepsis criteria; 20% mortality at 28 days among sepsis patients
• Gram-negative organisms accounted for 81% of bacteremia; tropical pathogens such as melioidosis (8%) and leptospirosis (4%) were common
• Sepsis-associated acute kidney injury on admission independently increased mortality risk (adjusted OR 2.07)

Guideline-Based Recommendations

Diagnosis

• Use SOFA score ≥2 with suspected infection to define sepsis, adapting respiratory criteria with SpO2/FiO2 when arterial blood gases unavailable
• Perform blood cultures and broad-spectrum antibiotic administration promptly on admission
• Assess for acute kidney injury using KDIGO criteria within 24 hours of admission

Management

• Administer broad-spectrum antibiotics early, even in absence of confirmed sepsis
• Recognize and manage critical illness features such as respiratory failure and shock outside ICU settings
• Modify traditional sepsis management approaches to accommodate resource limitations

Monitoring & Follow-up

• Monitor organ dysfunction including respiratory status and kidney function closely during hospitalization
• Perform lactate measurement when possible to assess severity, though it was done in only 43% of sepsis patients
• Follow patients up to 28 days post-admission to assess mortality outcomes

Risks

• Sepsis-associated acute kidney injury significantly increases mortality risk
• Limited access to ICU-level care may contribute to higher morbidity and mortality
• High prevalence of tropical and gram-negative pathogens necessitates tailored antibiotic strategies

Patient & Prescribing Data

Adults hospitalized with community-acquired infections in rural northeast Thailand

Broad-spectrum antibiotics were administered to over 95% of patients on admission; blood cultures were also obtained in over 95% of cases

Clinical Best Practices

• Early identification of sepsis using adapted SOFA criteria suitable for resource-limited settings
• Prompt initiation of broad-spectrum antibiotics and blood cultures upon hospital admission
• Close monitoring and management of sepsis-associated acute kidney injury to reduce mortality
• Recognition of critical illness signs outside ICU and adapting care accordingly
• Consideration of regional tropical pathogens in empirical treatment decisions

References

• Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3)
• KDIGO Clinical Practice Guideline for Acute Kidney Injury