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, , , , , , , , , , , , , , , , , and
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Singer M et al.2016. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315: 801–810.
-
2.
Rudd KE et al.2020. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 395: 200–211.
-
3.
World Health Organization , 2017. WHA 70: Main document A70/13: Improving the Prevention, Diagnosis and Clinical Management of Sepsis. Geneva, Switzerland: WHO. Available at: http://apps.who.int/gb/ebwha /pdf_files/ WHA70/A70_R7-en.pdf. Accessed January 9, 2021.
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4.
World Health Organization , 2018. Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. Geneva, Switzerland: WHO. Available at: https://www.who.int/healthinfo/ global_burden_disease/estimates/en/. Accessed January 12, 2021.
-
5.
Jacob ST et al., 2013. Integrating sepsis management recommendations into clinical care guidelines for district hospitals in resource-limited settings: the necessity to augment new guidelines with future research. BMC Med 11: 107.
-
6.
Obermeyer Z et al.2015. Emergency care in 59 low- and middle-income countries: a systematic review. Bull World Health Organ 93: 577G–586G.
-
7.
Ford N et al.2015. Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis. Lancet HIV 2: e438–e444.
-
8.
Rudd KE , Kissoon N , Limmathurotsakul D , Bory S , Mutahunga B , Seymour CW , Angus DC , West TE , 2018. The global burden of sepsis: barriers and potential solutions. Crit Care 22: 232.
-
9.
Lewis JM , Feasey NA , Rylance J , 2019. Aetiology and outcomes of sepsis in adults in sub-Saharan Africa: a systematic review and meta-analysis. Crit Care 23: 212.
-
10.
Morton B , Stolbrink M , Kagima W , Rylance J , Mortimer K , 2018. The early recognition and management of sepsis in sub-Saharan African adults: a systematic review and meta-analysis. Int J Environ Res Public Health 15: 2017.
-
11.
Silberberg B , Aston S , Boztepe S , Jacob S , Rylance J , 2020. Recommendations for fluid management of adults with sepsis in sub-Saharan Africa: a systematic review of guidelines. Crit Care 24: 286.
-
12.
Hanson J , Antsey N , Bihari D , White NJ , Day NP , Dondorp AM , 2014. The fluid management of adults with severe malaria. Crit Care 18: 642.
-
13.
Hodgson SH , Angus BJ , 2016. Malaria: fluid therapy in severe disease. BMJ Clin Evid 2016: 0913.
-
14.
Ministry of Health , 2017. Uganda HIV/AIDS Country Progress Report 2016–2017. Available at: https://www.unaids.org/sites/default/files/country/documents/UGA_2018_countryreport.pdf. Accessed January 9, 2021.
-
15.
National Malaria Control Programme and INFORM Project, KEMRI-Wellcome Trust , 2013. An Epidemiological Profile of Malaria and Its Control in Uganda. Available at: http://www.inform-malaria.org/wp-content/uploads/2014/05/Uganda-Epi-Report-060214.pdf. Accessed March 3, 2021.
-
16.
World Health Organization , 2011. IMAI District Clinician Manual: Hospital Care for Adolescents and Adults. Geneva, Switzerland: WHO. Available at: https://www.who.int/hiv/pub/imai/imai2011/en/. Accessed January 8, 2021.
-
17.
Andrews B , Semler MW , Muchemwa L , Kelly P , Lakhi S , Heimburger DC , Mabula C , Bwalya M , Bernard GR , 2017. Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: a randomized clinical trial. JAMA 318: 1233–1240.
-
18.
Andrews B , Muchemwa L , Kelly P , Lakhi S , Heimburger DC , Bernard GR , 2014. Simplified severe sepsis protocol: a randomized controlled trial of modified early goal-directed therapy in Zambia. Crit Care Med 42: 2315–2324.
-
19.
Maitland K et al.2011. Mortality after fluid bolus in African children with severe infection. N Engl J Med 364: 2483–2495.
-
20.
Uganda National Tuberculosis and Leprosy Control Programme, Ministry of Health , 2017. Manual for Management of and Control of Tuberculosis and Leprosy, 3rd edition. Available at: http://library.health.go.ug/download/file/fid/1428. Accessed March 4, 2021.
-
21.
Hulsen T , de Vlieg J , Alkema W , 2008. BioVenn: a web application for the comparison and visualization of biological lists using area-proportional Venn diagrams. BMC Genomics 9: 488.
-
22.
Drain PK , Hyle EP , Noubary F , Freedberg KA , Wilson D , Bishai WR , Rodriguez W , Bassett IV , 2014. Diagnostic point-of-care tests in resource-limited settings. Lancet Infect Dis 14: 239–249.
-
23.
Rello J et al.2016. Sepsis and septic shock in low-income and middle-income countries: need for a different paradigm. Int J Infect Dis 48: 120–122.
-
24.
Chaka W , Berger C , Huo S , Robertson V , Tachiona C , Magwenzi M , Magombei T , Mpamhanga C , Katzenstein D , Metcalfe J , 2020. Presentation and outcome of suspected sepsis in a high-HIV burden, high antiretroviral coverage setting. Int J Infect Dis 96: 276–283.
-
25.
Tadesse BT et al.2017. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis 17: 616.
-
26.
Lawn SD , Harries AD , Anglaret X , Myer L , Wood R , 2008. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. AIDS 22: 1897–1908.
-
27.
Barr DA et al.2020. Mycobacterium tuberculosis bloodstream infection prevalence, diagnosis, and mortality risk in seriously ill adults with HIV: a systematic review and meta-analysis of individual patient data. Lancet Infect Dis 20: 742–752.
-
28.
Cummings MJ , O’Donnell MR , 2015. Inverting the pyramid: increasing awareness of mycobacterial sepsis in sub-Saharan Africa. Int J Tuberc Lung Dis 19: 1128–1134.
-
29.
Hazard RH , Kagina P , Kitayimbwa R , Male K , McShane M , Mubiru D , Welikhe E , Moore CC , Abdallah A , 2019. Effect of empiric anti-Mycobacterium tuberculosis therapy on survival among human immunodeficiency virus-infected adults admitted with sepsis to a regional referral hospital in Uganda. Open Forum Infect Dis 14: ofz140.
-
30.
US National Library of Medicine ClinicalTrials.gov, 2020. Early Empiric Anti-Mycobacterium tuberculosis Therapy for Sepsis in Sub-Saharan Africa (ATLAS). Available at: https://clinicaltrials.gov/ct2/show/NCT04618198. Accessed January 19, 2021.
-
31.
Rudd KE et al.2018. Association of the quick sequential (sepsis-related) organ failure assessment (qSOFA) score with excess hospital mortality in adults with suspected infection in low- and middle-income countries. JAMA 319: 2202–2211.
-
32.
Moore CC et al.2017. Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa. BMJ Glob Health 2: e000344.
-
33.
Machado FR , Assunção MS , Cavalcanti AB , Japiassú AM , Azevedo LC , Oliveira MC , 2016. Getting a consensus: advantages and disadvantages of Sepsis-3 in the context of middle-income settings. Rev Bras Ter Intensiva 28: 361–365.
-
34.
Kalil AC , Machado FR , 2019. Quick sequential organ failure assessment is not good for ruling sepsis in or out. Chest 156: 197–199.
-
35.
Leligdowicz A , Matthay MA , 2019. Heterogeneity in sepsis: new biological evidence with clinical applications. Crit Care 23: 80.
-
36.
Cummings MJ , Goldberg E , Mwaka S , Kabajaasi O , Vittinghoff E , Cattamanchi A , Katamba A , Kenya-Mugisha N , Jacob ST , Davis JL , 2017. A complex intervention to improve implementation of World Health Organization guidelines for diagnosis of severe illness in low-income settings: a quasi-experimental study from Uganda. Implement Sci 6: 126.
-
37.
Rhodes A et al.2017. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 45: 486–552.
-
38.
Jacob ST et al.2012. The impact of early monitored management on survival in hospitalized adult Ugandan patients with severe sepsis: a prospective intervention study. Crit Care Med 40: 2050–2058.
-
39.
Riviello E , Pisani L , Schultz MJ , 2016. What’s new in ARDS: ARDS also exists in resource-constrained settings. Intensive Care Med 42: 794–796.
-
40.
Riviello ED , Kiviri W , Twagirumugabe T , Mueller A , Banner-Goodspeed VM , Officer L , Novack V , Mutumwinka M , Talmor DS , Fowler RA , 2016. Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali modification of the Berlin definition. Am J Respir Crit Care Med 193: 52–59.
-
41.
Kwizera A et al.2020. Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality. BMJ Open Respir Res 7: e000719.
-
42.
Florescu DF , Kalil AC , 2014. The complex link between influenza and severe sepsis. Virulence 5: 137–142.
-
43.
Kalil AC , Thomas PG , 2019. Influenza virus-related critical illness: pathophysiology and epidemiology. Crit Care 23: 258.
-
44.
McMorrow ML et al.2015. Severe acute respiratory illness deaths in sub-Saharan Africa and the role of influenza: a case series from 8 countries. J Infect Dis 212: 853–860.
-
45.
Radin JM et al.2012. Influenza surveillance in 15 countries in Africa, 2006–2010. J Infect Dis 206 (Suppl 1): S14–S21.
-
46.
Cummings MJ et al.2016. Epidemiologic and spatiotemporal characterization of influenza and severe acute respiratory infection in Uganda, 2010–2015. Ann Am Thorac Soc 13: 2159–2168.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2331 | 1166 | 247 |
| Full Text Views | 218 | 25 | 0 |
| PDF Downloads | 179 | 31 | 1 |
Stratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective Cohort Study
Matthew J. Cummings
Matthew J. Cummings
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York;
Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York;
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Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York;
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Barnabas Bakamutumaho
Barnabas Bakamutumaho
Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda;
Immunizable Diseases Unit, Uganda Virus Research Institute, Entebbe, Uganda;
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Immunizable Diseases Unit, Uganda Virus Research Institute, Entebbe, Uganda;
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Nicholas Owor
Nicholas Owor
Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda;
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John Kayiwa
John Kayiwa
Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda;
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Joyce Namulondo
Joyce Namulondo
Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda;
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Timothy Byaruhanga
Timothy Byaruhanga
Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda;
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Moses Muwanga
Moses Muwanga
Entebbe General Referral Hospital, Ministry of Health, Entebbe, Uganda;
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Christopher Nsereko
Christopher Nsereko
Entebbe General Referral Hospital, Ministry of Health, Entebbe, Uganda;
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Matthew R. Baldwin
Matthew R. Baldwin
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York;
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Julius J. Lutwama
Julius J. Lutwama
Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda;
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Max R. O’Donnell
Max R. O’Donnell
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York;
Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York;
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York;
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ABSTRACT.
The global burden of sepsis is concentrated in sub-Saharan Africa, where extensive pathogen diversity and limited laboratory capacity challenge targeted antimicrobial management of life-threatening infections. In this context, established and emerging rapid pathogen diagnostics may stratify sepsis patients into subgroups with prognostic and therapeutic relevance. In a prospective cohort of adults (age ≥18 years) hospitalized with suspected sepsis in Uganda, we stratified patients using rapid diagnostics for HIV, tuberculosis (TB), malaria, and influenza, and compared clinical characteristics and 30-day outcomes across these pathogen-driven subgroups. From April 2017 to August 2019, 301 adults were enrolled (median age, 32 years [interquartile range, 26–42 years]; female, n = 178 [59%]). A total of 157 patients (53%) were HIV infected. Sixty-one patients (20%) tested positive for malaria, 52 (17%), for TB (including 49 of 157 [31%] HIV-infected patients), and 17 (6%), for influenza. Co-infection was identified in 33 (11%) patients. The frequency of multi-organ failure, including shock and acute respiratory failure, was greatest among patients with HIV-associated TB. Mortality at 30 days was 19% among patients with malaria, 40% among patients with HIV-associated TB, 32% among HIV-infected patients without microbiological evidence of TB, 6% among patients with influenza, and 11% among patients without a pathogen identified. Despite improvements in anti-retroviral delivery, the burden of sepsis in Uganda remains concentrated among young, HIV-infected adults, with a high incidence of severe HIV-associated TB. In parallel with improvements in acute-care capacity, use of rapid pathogen diagnostics may enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region.
- Supplemental Materials (DOC 276 KB)
Author Notes
Financial support: This work was supported by the National Institute of Allergy and Infectious Diseases (F32AI147528-01 to M. J. C.), the National Center for Advancing Translational Sciences (UL1TR001873 to Columbia University, sub-award to M. R. O.] the National Institutes of Health and the Stony Wold-Herbert Fund (M. J. C.), the Potts Memorial Foundation (M. J. C.), and the Burroughs Wellcome Fund/American Society of Tropical Medicine and Hygiene (M. J. C.). Additional support was provided through the DELTAS Africa Initiative (grant no. 107743). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences, Alliance for Accelerating Excellence in Science in Africa and is supported by the New Partnership for Africa’s Development Planning and Coordinating Agency with funding from the Wellcome Trust (grant no. 107743) and the UK government.
Disclaimer: The funders had no role in study design, data analysis and interpretation, manuscript preparation, or decision to publish.
Authors’ addresses: Matthew J. Cummings, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, and the Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, E-mail: mjc2244@columbia.edu. Barnabas Bakamutumaho, Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda, and the Immunizable Diseases Unit, Uganda Virus Research Institute, Entebbe, Uganda, E-mail: bbarnabas2001@yahoo.com. Nicholas Owor, John Kayiwa, Joyce Namulondo, Timothy Byaruhanga, and Julius J. Lutwama, Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda, E-mails: nicowor@gmail.com, jkayiwa@yahoo.com, jonacla.j@gmail.com, tssekandi@gmail.com, and jjlutwama03@yahoo.com. Moses Muwanga and Christopher Nsereko, Entebbe General Referral Hospital, Ministry of Health, Entebbe, Uganda, E-mails: docmuwanga@yahoo.com and chrisdoc23@yahoo.com. Matthew R. Baldwin, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, E-mail: mrb45@columbia.edu. Max R. O’Donnell, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, E-mail: mo2130@columbia.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Singer M et al.2016. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 315: 801–810.
-
2.
Rudd KE et al.2020. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 395: 200–211.
-
3.
World Health Organization , 2017. WHA 70: Main document A70/13: Improving the Prevention, Diagnosis and Clinical Management of Sepsis. Geneva, Switzerland: WHO. Available at: http://apps.who.int/gb/ebwha /pdf_files/ WHA70/A70_R7-en.pdf. Accessed January 9, 2021.
-
4.
World Health Organization , 2018. Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. Geneva, Switzerland: WHO. Available at: https://www.who.int/healthinfo/ global_burden_disease/estimates/en/. Accessed January 12, 2021.
-
5.
Jacob ST et al., 2013. Integrating sepsis management recommendations into clinical care guidelines for district hospitals in resource-limited settings: the necessity to augment new guidelines with future research. BMC Med 11: 107.
-
6.
Obermeyer Z et al.2015. Emergency care in 59 low- and middle-income countries: a systematic review. Bull World Health Organ 93: 577G–586G.
-
7.
Ford N et al.2015. Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis. Lancet HIV 2: e438–e444.
-
8.
Rudd KE , Kissoon N , Limmathurotsakul D , Bory S , Mutahunga B , Seymour CW , Angus DC , West TE , 2018. The global burden of sepsis: barriers and potential solutions. Crit Care 22: 232.
-
9.
Lewis JM , Feasey NA , Rylance J , 2019. Aetiology and outcomes of sepsis in adults in sub-Saharan Africa: a systematic review and meta-analysis. Crit Care 23: 212.
-
10.
Morton B , Stolbrink M , Kagima W , Rylance J , Mortimer K , 2018. The early recognition and management of sepsis in sub-Saharan African adults: a systematic review and meta-analysis. Int J Environ Res Public Health 15: 2017.
-
11.
Silberberg B , Aston S , Boztepe S , Jacob S , Rylance J , 2020. Recommendations for fluid management of adults with sepsis in sub-Saharan Africa: a systematic review of guidelines. Crit Care 24: 286.
-
12.
Hanson J , Antsey N , Bihari D , White NJ , Day NP , Dondorp AM , 2014. The fluid management of adults with severe malaria. Crit Care 18: 642.
-
13.
Hodgson SH , Angus BJ , 2016. Malaria: fluid therapy in severe disease. BMJ Clin Evid 2016: 0913.
-
14.
Ministry of Health , 2017. Uganda HIV/AIDS Country Progress Report 2016–2017. Available at: https://www.unaids.org/sites/default/files/country/documents/UGA_2018_countryreport.pdf. Accessed January 9, 2021.
-
15.
National Malaria Control Programme and INFORM Project, KEMRI-Wellcome Trust , 2013. An Epidemiological Profile of Malaria and Its Control in Uganda. Available at: http://www.inform-malaria.org/wp-content/uploads/2014/05/Uganda-Epi-Report-060214.pdf. Accessed March 3, 2021.
-
16.
World Health Organization , 2011. IMAI District Clinician Manual: Hospital Care for Adolescents and Adults. Geneva, Switzerland: WHO. Available at: https://www.who.int/hiv/pub/imai/imai2011/en/. Accessed January 8, 2021.
-
17.
Andrews B , Semler MW , Muchemwa L , Kelly P , Lakhi S , Heimburger DC , Mabula C , Bwalya M , Bernard GR , 2017. Effect of an early resuscitation protocol on in-hospital mortality among adults with sepsis and hypotension: a randomized clinical trial. JAMA 318: 1233–1240.
-
18.
Andrews B , Muchemwa L , Kelly P , Lakhi S , Heimburger DC , Bernard GR , 2014. Simplified severe sepsis protocol: a randomized controlled trial of modified early goal-directed therapy in Zambia. Crit Care Med 42: 2315–2324.
-
19.
Maitland K et al.2011. Mortality after fluid bolus in African children with severe infection. N Engl J Med 364: 2483–2495.
-
20.
Uganda National Tuberculosis and Leprosy Control Programme, Ministry of Health , 2017. Manual for Management of and Control of Tuberculosis and Leprosy, 3rd edition. Available at: http://library.health.go.ug/download/file/fid/1428. Accessed March 4, 2021.
-
21.
Hulsen T , de Vlieg J , Alkema W , 2008. BioVenn: a web application for the comparison and visualization of biological lists using area-proportional Venn diagrams. BMC Genomics 9: 488.
-
22.
Drain PK , Hyle EP , Noubary F , Freedberg KA , Wilson D , Bishai WR , Rodriguez W , Bassett IV , 2014. Diagnostic point-of-care tests in resource-limited settings. Lancet Infect Dis 14: 239–249.
-
23.
Rello J et al.2016. Sepsis and septic shock in low-income and middle-income countries: need for a different paradigm. Int J Infect Dis 48: 120–122.
-
24.
Chaka W , Berger C , Huo S , Robertson V , Tachiona C , Magwenzi M , Magombei T , Mpamhanga C , Katzenstein D , Metcalfe J , 2020. Presentation and outcome of suspected sepsis in a high-HIV burden, high antiretroviral coverage setting. Int J Infect Dis 96: 276–283.
-
25.
Tadesse BT et al.2017. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis 17: 616.
-
26.
Lawn SD , Harries AD , Anglaret X , Myer L , Wood R , 2008. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. AIDS 22: 1897–1908.
-
27.
Barr DA et al.2020. Mycobacterium tuberculosis bloodstream infection prevalence, diagnosis, and mortality risk in seriously ill adults with HIV: a systematic review and meta-analysis of individual patient data. Lancet Infect Dis 20: 742–752.
-
28.
Cummings MJ , O’Donnell MR , 2015. Inverting the pyramid: increasing awareness of mycobacterial sepsis in sub-Saharan Africa. Int J Tuberc Lung Dis 19: 1128–1134.
-
29.
Hazard RH , Kagina P , Kitayimbwa R , Male K , McShane M , Mubiru D , Welikhe E , Moore CC , Abdallah A , 2019. Effect of empiric anti-Mycobacterium tuberculosis therapy on survival among human immunodeficiency virus-infected adults admitted with sepsis to a regional referral hospital in Uganda. Open Forum Infect Dis 14: ofz140.
-
30.
US National Library of Medicine ClinicalTrials.gov, 2020. Early Empiric Anti-Mycobacterium tuberculosis Therapy for Sepsis in Sub-Saharan Africa (ATLAS). Available at: https://clinicaltrials.gov/ct2/show/NCT04618198. Accessed January 19, 2021.
-
31.
Rudd KE et al.2018. Association of the quick sequential (sepsis-related) organ failure assessment (qSOFA) score with excess hospital mortality in adults with suspected infection in low- and middle-income countries. JAMA 319: 2202–2211.
-
32.
Moore CC et al.2017. Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa. BMJ Glob Health 2: e000344.
-
33.
Machado FR , Assunção MS , Cavalcanti AB , Japiassú AM , Azevedo LC , Oliveira MC , 2016. Getting a consensus: advantages and disadvantages of Sepsis-3 in the context of middle-income settings. Rev Bras Ter Intensiva 28: 361–365.
-
34.
Kalil AC , Machado FR , 2019. Quick sequential organ failure assessment is not good for ruling sepsis in or out. Chest 156: 197–199.
-
35.
Leligdowicz A , Matthay MA , 2019. Heterogeneity in sepsis: new biological evidence with clinical applications. Crit Care 23: 80.
-
36.
Cummings MJ , Goldberg E , Mwaka S , Kabajaasi O , Vittinghoff E , Cattamanchi A , Katamba A , Kenya-Mugisha N , Jacob ST , Davis JL , 2017. A complex intervention to improve implementation of World Health Organization guidelines for diagnosis of severe illness in low-income settings: a quasi-experimental study from Uganda. Implement Sci 6: 126.
-
37.
Rhodes A et al.2017. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 45: 486–552.
-
38.
Jacob ST et al.2012. The impact of early monitored management on survival in hospitalized adult Ugandan patients with severe sepsis: a prospective intervention study. Crit Care Med 40: 2050–2058.
-
39.
Riviello E , Pisani L , Schultz MJ , 2016. What’s new in ARDS: ARDS also exists in resource-constrained settings. Intensive Care Med 42: 794–796.
-
40.
Riviello ED , Kiviri W , Twagirumugabe T , Mueller A , Banner-Goodspeed VM , Officer L , Novack V , Mutumwinka M , Talmor DS , Fowler RA , 2016. Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali modification of the Berlin definition. Am J Respir Crit Care Med 193: 52–59.
-
41.
Kwizera A et al.2020. Acute hypoxaemic respiratory failure in a low-income country: a prospective observational study of hospital prevalence and mortality. BMJ Open Respir Res 7: e000719.
-
42.
Florescu DF , Kalil AC , 2014. The complex link between influenza and severe sepsis. Virulence 5: 137–142.
-
43.
Kalil AC , Thomas PG , 2019. Influenza virus-related critical illness: pathophysiology and epidemiology. Crit Care 23: 258.
-
44.
McMorrow ML et al.2015. Severe acute respiratory illness deaths in sub-Saharan Africa and the role of influenza: a case series from 8 countries. J Infect Dis 212: 853–860.
-
45.
Radin JM et al.2012. Influenza surveillance in 15 countries in Africa, 2006–2010. J Infect Dis 206 (Suppl 1): S14–S21.
-
46.
Cummings MJ et al.2016. Epidemiologic and spatiotemporal characterization of influenza and severe acute respiratory infection in Uganda, 2010–2015. Ann Am Thorac Soc 13: 2159–2168.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2331 | 1166 | 247 |
| Full Text Views | 218 | 25 | 0 |
| PDF Downloads | 179 | 31 | 1 |