Intensive Care Medicine

, Volume 43, Issue 5, pp 612–624

Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future

  • Marcus J. Schultz
  • Martin W. Dunser
  • Arjen M. Dondorp
  • Neill K. J. Adhikari
  • Shivakumar Iyer
  • Arthur Kwizera
  • Yoel Lubell
  • Alfred Papali
  • Luigi Pisani
  • Beth D. Riviello
  • Derek C. Angus
  • Luciano C. Azevedo
  • Tim Baker
  • Janet V. Diaz
  • Emir Festic
  • Rashan Haniffa
  • Randeep Jawa
  • Shevin T. Jacob
  • Niranjan Kissoon
  • Rakesh Lodha
  • Ignacio Martin-Loeches
  • Ganbold Lundeg
  • David Misango
  • Mervyn Mer
  • Sanjib Mohanty
  • Srinivas Murthy
  • Ndidiamaka Musa
  • Jane Nakibuuka
  • Ary Serpa Neto
  • Mai Nguyen Thi Hoang
  • Binh Nguyen Thien
  • Rajyabardhan Pattnaik
  • Jason Phua
  • Jacobus Preller
  • Pedro Povoa
  • Suchitra Ranjit
  • Daniel Talmor
  • Jonarthan Thevanayagam
  • C. Louise Thwaites
  • For the Global Intensive Care Working Group of the European Society of Intensive Care Medicine
Review

DOI: 10.1007/s00134-017-4750-z

Cite this article as:
Schultz, M.J., Dunser, M.W., Dondorp, A.M. et al. Intensive Care Med (2017) 43: 612. doi:10.1007/s00134-017-4750-z

Abstract

Background

Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome.

Aim

To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU.

Findings

Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources.

Conclusions

Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

Keywords

Sepsis management Critical care Resource-limited settings 

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  • Marcus J. Schultz
    • 1
    • 2
  • Martin W. Dunser
    • 3
  • Arjen M. Dondorp
    • 1
    • 2
  • Neill K. J. Adhikari
    • 4
  • Shivakumar Iyer
    • 5
  • Arthur Kwizera
    • 6
  • Yoel Lubell
    • 2
  • Alfred Papali
    • 7
  • Luigi Pisani
    • 1
    • 2
  • Beth D. Riviello
    • 8
  • Derek C. Angus
    • 9
  • Luciano C. Azevedo
    • 10
  • Tim Baker
    • 11
  • Janet V. Diaz
    • 12
  • Emir Festic
    • 13
  • Rashan Haniffa
    • 1
  • Randeep Jawa
    • 14
  • Shevin T. Jacob
    • 15
  • Niranjan Kissoon
    • 16
  • Rakesh Lodha
    • 17
  • Ignacio Martin-Loeches
    • 18
  • Ganbold Lundeg
    • 19
  • David Misango
    • 20
  • Mervyn Mer
    • 21
  • Sanjib Mohanty
    • 22
  • Srinivas Murthy
    • 16
  • Ndidiamaka Musa
    • 23
  • Jane Nakibuuka
    • 6
  • Ary Serpa Neto
    • 2
    • 24
  • Mai Nguyen Thi Hoang
    • 25
  • Binh Nguyen Thien
    • 26
  • Rajyabardhan Pattnaik
    • 22
  • Jason Phua
    • 27
  • Jacobus Preller
    • 28
  • Pedro Povoa
    • 29
  • Suchitra Ranjit
    • 30
  • Daniel Talmor
    • 8
  • Jonarthan Thevanayagam
    • 31
  • C. Louise Thwaites
    • 32
  • For the Global Intensive Care Working Group of the European Society of Intensive Care Medicine
  1. 1.Mahidol UniversityBangkokThailand
  2. 2.Department of Intensive CareAcademic Medical Center and University of AmsterdamAmsterdamThe Netherlands
  3. 3.University College of London HospitalLondonUK
  4. 4.Sunnybrook Health Sciences Centre and University of TorontoTorontoCanada
  5. 5.Bharati Vidyapeeth Deemed University Medical CollegePuneIndia
  6. 6.Mulago National Referral HospitalKampalaUganda
  7. 7.University of Maryland School of MedicineBaltimoreUSA
  8. 8.Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  9. 9.University of PittsburghPittsburghUSA
  10. 10.Hospital Sirio-LibanesSaõ PauloBrazil
  11. 11.Karolinska InstituteStockholmSweden
  12. 12.California Pacific Medical CenterSan FranciscoUSA
  13. 13.Mayo ClinicJacksonvilleUSA
  14. 14.Stony Brook University Medical CenterStony BrookUSA
  15. 15.University of WashingtonSeattleUSA
  16. 16.British Columbia Children’s HospitalVancouverCanada
  17. 17.All India Institute of Medical ScienceDelhiIndia
  18. 18.St. James’s University HospitalDublinIreland
  19. 19.Mongolian National University of Medical SciencesUlaanbaatarMongolia
  20. 20.Aga Khan University HospitalNairobiKenya
  21. 21.Johannesburg Hospital and University of the WitwatersrandJohannesburgSouth Africa
  22. 22.Ispat General HospitalRourkelaIndia
  23. 23.Seattle Children’s Hospital and University of WashingtonSeattleUSA
  24. 24.Medical Intensive Care UnitHospital Israelita Albert EinsteinSao PauloBrazil
  25. 25.Oxford University Clinical Research UnitHospital for Tropical DiseasesHo Chi Minh CityVietnam
  26. 26.Trung Vuong HospitalHo Chi Minh CityVietnam
  27. 27.National University HospitalSingaporeSingapore
  28. 28.Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
  29. 29.Nova Medical School, CEDOC, New University of Lisbon and Hospital de Sao Francisco Xavier Centro Hospitalar de Lisboa OcidentalLisbonPortugal
  30. 30.Appolo HospitalsChennaiIndia
  31. 31.Mzuzu Central HospitalMzuzuMalawi
  32. 32.Nuffield Department of Medicine, Centre for Tropical Medicine and Global HealthUniversity of OxfordOxfordUK

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