Abstract:

Background: Sepsis is a common cause of admission and death in Adult Intensive Care Units (AICU) in the world. Very is known of the incidence of sepsis in AICU’s in low and Middle Income Countries. Early diagnosis of sepsis is critical in reducing associated morbidity and mortality. Difficulty in diagnosing sepsis and the unregulated use of antibiotics is a significant concern in the Sub Saharan Africa. Resistance to first line agents has been demonstrated in the neonatal unit at Bugando Medical Centre but limited data are available from the adult intensive care unit.

Objective: To determine the prevalence, microbiological patterns and patterns and factors associated with sepsis among adult patients admitted to the adult intensive care unit of the Bugando Medical Centre Mwanza, north-western Tanzania.

Method: All patients above 18 years of age with a clinical diagnosis of sepsis admitted to the AICU of Bugando Medical Centre were included. Microbiological assessment included blood, urine cerebrospinal fluid, tracheal aspirates and wound swab cultures. Patients’ social demographic and clinical data were collected using a standardized data collection tool. Data was analyzed by the use of the STATA, version 13.

Results: During the 10 months of the study period, a total of 357 patients were admitted in AICU with different clinical diagnosis. Of them, 116 (32.5%) patients were clinically diagnosed to be septic and were included in the final analysis, among them, 59(50.90%) were confirmed to be microbiologically culture positive. The median age of the septic and non-septic patients was 40(28-57) and 39(28-56), respectively (P=0.07). The majority of septic patients were male, 68(58.6%) and only 30 (25.9%) had health care insurance. The majority 98(84.5%) of patients were admitted as referrals, while 18 patients (15.5%) were self-referrals. During their stay, 63(54.3%) died. Bacterial detected were K. pneumoniae, E. coli, Acinetobacter spp and S. aureus. Being a female (OR 2.36[95% CI 1.05-5.12]), p=0.03 as well staying with the urinary catheters >14 days (OR 3.21[95% CI, 1.01 – 10.13], p=0.05) were associated with an increased risk of developing sepsis. Diabetic ketoacidosis (DKA), p=0.03 and AICU stay>2 days, p=0.02 were found to independently predict in-hospital mortality being protective with OR of 0.18 and 0.15 respectively.

Conclusion: In this study, approximately half of the patients who were clinically diagnosed to have sepsis were also microbiologically confirmed, and the prevalence was similar to what has been reported in other studies. The majority of pathogens were due to multi-drug resistant bacteria. Only one isolate of K. pneumonie was resistant to all tested antibiotics including even meropenem, though representing 3.7% of meropenem resistance of all isolates for K. pneumonie. Early diagnosis of sepsis and appropriate microbiology interventions can reduce patient mortality. Knowledge of antibiotic sensitivities will aid us in the development of an AICU specific antibiotic prescribing protocol.