How to recognise sepsis in resource-poor settings

Scientists have created a set of recommendations for how medical professionals can easily recognise sepsis and determine which microorganisms are causing the infection. These guidelines allow medical staff in resource-poor settings to treat this deadly condition early and effectively.

Sepsis, which is sometimes called blood poisoning, is a condition where the body’s immune system damages body tissues while trying to fight an infection. Left untreated, sepsis can turn into septic shock, causing organ failure and even death.

To prevent this, medical staff must identify sepsis as quickly as possible. They also need to identify the microorganisms causing the infection that led to sepsis.  Usually these are bacteria, but they can also be fungi, viruses or even malaria parasites.

In resource-limited areas, however, medical staff are not always properly trained in how to recognise the condition. Symptoms of sepsis can also be different in children, or when it’s caused by non-bacterial organisms.

Because of these challenges, researchers wrote a guide summarising medical recommendations for how to identify sepsis with straightforward tools and strategies.

According to the researchers, the easiest way to detect sepsis is if patients who have an infection also show certain changes like rapid breathing, low blood pressure or changes in mental state, such as being confused. They also state that medical staff should be familiar with local diseases that can cause sepsis, like malaria and dengue fever.

To identify the cause of infections and sepsis, the researchers recommend detailed physical examinations of patients. They add that using microscopy and Gram staining, which is a technique for identifying certain types of bacteria, staff should be able to find the microorganism responsible. 

They note that it is particularly important for medical staff who aren’t doctors to also be able to recognise infections and sepsis, and that they should be supported with the right training to do so.

Correct identification of the microorganisms causing an infection ensures that patients are given the right antibiotics. Because some microorganisms become resistant to (able to survive) antibiotics, the researchers add that testing for resistance is an important step, but not always possible in resource-poor settings.

In the last section of their guide, the researchers discuss how to identify septic shock, which can quickly lead to death if untreated. In such cases, they say that medical staff should watch out for signs that there isn’t enough oxygen reaching the patient’s tissues. In some cases, signs like mottled skin can also indicate organ failure or even that a patient is close to death.

The researchers say more work should be done on sepsis in resource-poor settings since much of what we know about the condition has been researched in resource-rich areas.

The work is a collaboration between scientists based in Uganda, Canada, USA, Thailand, Austria, Ireland, and Mongolia. The guidelines form part of a book on managing sepsis in resource-limited settings that can be downloaded for free by healthcare workers across the world.

Abstract

In this chapter, we summarize recommendations on sepsis recognition, identification of the underlying infection and causative microbiological pathogen, as well as recognition of septic shock in resource-limited settings. Early recognition of sepsis is based on the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA): respiratory rate ≥22 bpm, systolic blood pressure ≤100 mmHg, and any acute change in mental state. For patients with severe malaria and severe dengue, more disease-specific criteria are of additional value. Identifying the cause and source of infection is important for the choice of treatment, to which knowledge of the local epidemiology, physical examination, and, depending on their availability, laboratory testing and imaging can contribute. If feasible, microbiological cultures before antimicrobial therapy, microscopy, and Gram staining of secretions sampled from the suspected source of infection should be performed. Empirical antibiotic therapy should be informed considering local antimicrobial resistance patterns, and if available follow-on antibiotic therapy should be guided by the antibiotic susceptibility of cultured bacteria. Malaria is diagnosed by rapid diagnostic test or light microscopy of a peripheral blood smear. Antigen or antibody tests are available for specific virus infections such as dengue, influenza, or Ebola virus disease. In immunocompromised patients, coinfection with tuberculosis should be suspected. For the diagnosis of septic shock, clinical indicators of systemic tissue hypoperfusion should be assessed. It is insufficient to rely solely on the presence of arterial hypotension, as arterial hypotension can be a late event. Plasma lactate is an important indicator of tissue hypoperfusion with strong prognostic significance.

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