A study conducted in southern India found that sepsis disproportionately affects younger and mostly rural groups and that gram-negative bacteria, viruses, and tropical diseases are significant causes, researchers reported today in Clinical Infectious Diseases.
To gain insight into the causative agents and characteristics of patients with community-acquired sepsis in India, which accounts for 26% of global sepsis-related deaths, a team of researchers from India, the Netherlands, and the United Kingdom conducted a prospective observational study in a tertiary-care hospital in South India from December 2018 through September 2022. They enrolled adult patients within 24 hours of intensive care unit admission (ICU) who met international sepsis criteria and collected clinical, microbiologic, demographic, and outcome data.
Of the 4,000 patients screened on ICU admission, 1,000 (median age, 55 years; 66% male) met the inclusion criteria. Most patients lived outside of urban areas, with 23.7% living in towns and 46.5% in villages, while roughly half had no formal education, and three-quarters worked in the primary sector. The median length of ICU stay was 4 days, and in-hospital mortality was 24.1%.
Study fills important knowledge gaps
A causative agent could be identified in 54% of patients, with bacteria causing 38% of cases, viruses 18%, leptospirosis 10.6%, scrub typhus 4.1%, dengue 3.7%, and Kyasanur forest disease virus (KFDV) 1.6%. Sepsis cases caused by leptospirosis, scrub typhus, dengue, and KFDV all showed seasonal variation around the monsoon season.
Among patients with bacterial sepsis, 43.9% of isolates were gram-negative; Escherichia coli (52.3%), Klebsiella pneumoniae (23.3%), and Pseudomonas aeruginosa (5.3%) were the most frequently isolated species. Further analysis found high levels of antibiotic resistance, with 75.8% of E coli, 47.7% of K pneumoniae, and 30% of P aeruginosa resistant to third-generation cephalosporins and 10.1%, 13.6%, and 10.0% resistant to carbapenems, respectively.
“This study provides a detailed examination of sepsis in South India and fills important knowledge gaps of the real burden of sepsis in LMICs [low- and middle-income countries],” the study authors wrote. “These findings provide critical groundwork for strengthening capacity, optimizing resource allocation, and formulating evidence-based treatment guidelines specifically tailored to South Asia, underscoring the importance of regional epidemiologic sepsis research in LMICs.”
