Burden and bacteriological profile of sepsis among adult medical emergencies presenting to a national referral hospital in Kampala, Uganda

IntroductionSepsis, defined as life-threatening organ dysfunction due to dysregulated host response to infection can result from any infection. In 2017, an estimated 48.9 million incident cases of sepsis and 11.8 million sepsis-related deaths were reported globally. Bacterial infection is the major cause of sepsis. Data about sepsis burden is derived almost exclusively from studies in high-income countries yet mortality from sepsis is disproportionately higher in low- and middle-income countries. We aimed to determine the prevalence of sepsis, bacteriological profile of causes, antimicrobial susceptibility patterns, and in-hospital outcomes among adult medical emergencies presenting to Kiruddu National Referral Hospital in Kampala, Uganda. MethodsWe conducted a prospective cohort study between December 2018 and July 2019 in which patients presenting to the medical emergency ward with sepsis were consecutively enrolled; blood was drawn for aerobic blood cultures, antimicrobial susceptibility patterns were determined and patients were followed up for in-hospital outcomes. ResultsOf 1,657 patients screened during the study period, 243(14.7%) had sepsis, the median age was 45 years (IQR 32,65) and the majority were female (55.6%). Among patients with sepsis; 46 (18.9%) had positive aerobic blood cultures. Staphylococcus aureus was the most common isolate (31/46, 67.4%) with a predominance of Methicillin-Resistant Staphylococcus aureus (MRSA) (20/31, 64.5%). Of the 243 patients followed up, 143 (58.9%) died in hospital with an average length of stay of 4.9 days (SD 5.5) for those who died and 10.2 (SD 7.6) for those that were discharged alive. None of the patients was admitted to ICU. ConclusionsSepsis was common (14.7%) among adult medical emergencies and it was associated with a high in-hospital mortality rate (58.9%). Positive blood cultures were predominantly Staphylococcus aureus and nearly a third of these were Methicillin-Resistant.