Prevalence and Incidence of Infections and Sepsis in Critical Care Units at Two Tertiary Referral Hospitals in Kenya

Abstract

Background: Sepsis is a major global challenge affecting millions of individuals yearly. The incidence of sepsis has been estimated to be 535 per 100000 person-years however, this varies by geographical region. In Critical care units, sepsis accounts for 29% of Critical care unit (CCU) admissions with an estimated mortality of 25%. common causes of sepsis are respiratory tract infections, intra-abdominal infections, urosepsis, and catheter-related bloodstream infections. Nosocomial infections are frequent causes of sepsis in Intensive Care Units, with patients having a 2-5 times increased risk of developing nosocomial infections as compared to the general hospital population. The prevalence of multi-drug resistant infections is also significantly higher with Multidrug-Resistant Organisms (MDROs) such as Pseudomonas and Acinetobacter being responsible for a large portion of nosocomial infections. Objectives: To determine three-month period prevalence and incidence rates of infections, sepsis and septic shock in adult patients admitted to CCU’s at tertiary care hospitals in Nairobi. We aimed to document primary infection foci,causative organisms, and their antibiotic susceptibility patterns. We also aimed to determine the 28-day case fatality rates in patients with infections, sepsis, and septic shock. Study Design: This was a hospital-based prospective observational study among patients admitted to the adult Critical Care Units at the Kenyatta National Hospital and the M.P Shah Hospital carried out between December 2020 and March 2021 Study Site and Subjects: The Kenyatta National Hospital (KNH) is a national tertiary referral hospital with an 1800 bed capacity, medical Critical Care Units (CCU’s)with six beds each as well as a multidisciplinary CCU with 20 beds. The M.P. Shah Hospital is a 200-bed private tertiary level facility with a 16 bed CCU. All consecutive patients admitted to these adult CCU’s meeting the inclusion criteria were eligible to participate in the study. Methods: All patients admitted to the Critical Care Units were evaluated on admission using the International Sepsis Forum (ISF) Consensus definitions for presence of infection(s). The Sequential Organ Failure Assessment (SOFA) score was applied to all patients to identify those with sepsis. A patient case report form was used to collect data and patients were followed up from admission to discharge from the CCU. Patients were assessed at intervals for development of incident infections, sepsis and septic shock. Microbiologic culture reports were also documented to determine isolates and antibiotic susceptibility patterns.