Prevalence of sepsis, outcomes, and associated factors among adult patients admitted to the intensive care unit at Muhimbili national hospital.

Abstract

ABSTRACT Background It is estimated there are 49 million cases of sepsis with 20% deaths each year globally with a high mortality in low- and middle-income countries. Despite the development of several strategies to alleviate this burden, sepsis has remained the leading cause of death in intensive care units and, it is responsible for approximately six million deaths worldwide. Aim of the study This study aimed to determine the prevalence of sepsis, outcomes, and factors associated among adult patients admitted to the Intensive Care Unit at Muhimbili National Hospital. Methodology A hospital-based analytical cross-sectional study was conducted at Muhimbili National Hospital in the Adult Intensive Care Units. The study was conducted for six months and involved 248 patients and 56 healthcare workers. Data was collected using standard checklists and a questionnaire. Statistical analysis was done using Statistical Package for Social Sciences (version 26), and proportion was used to determine prevalence and outcome. A Chi-square test and logistic regression were done to establish an association between patient outcomes and associated factors. A p-value ≤ 0.05 and a 95% confidence interval were used as a cutoff point for statistically significant variables. Results The prevalence of sepsis was 41.5% (103/248), with 55% mortality. After adjusting for confounders, the study showed early initiation of a broad-spectrum antibiotic (aPR=16.89; CI:2.32-122.86; p=0.005) was significantly associated with good patient outcomes. However, a higher SOFA score (aPR=0.61; CI:0.43-0.88; p=0.007) was significantly associated with poor outcomes. xiii The study also observed nonuse of specific guidelines in diagnosing and managing sepsis, a lack of important diagnostic tools, a lack of formal training, and inadequate knowledge in early recognition and management of sepsis among nurses. Conclusion and recommendation This study revealed a high prevalence of sepsis and case-related mortality. It also highlights the importance of early sepsis recognition and management, particularly proper screening, diagnosis of patients, and early initiation of broad-spectrum antibiotics. Challenges such as inadequate knowledge, lack of formal institutional training, lack of guideline use, and unavailability of necessary resources can impact patient care. We recommend proper screening of patients for sepsis in the ICU to ensure early recognition and management. Also, providing comprehensive sepsis management training for healthcare workers, and ensuring essential medications and equipment are available to improve patient outcomes.