The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health and Ageing. “
“Severe sepsis is a leading non-cardiovascular cause of death in critically ill patients worldwide, with 90% of deaths from pneumonia, meningitis and other infections occurring in low-resource settings. In countries such as Malawi, where there

is a high burden of HIV-related disease,1 sepsis is thought to be a major killer. However, CHIR-99021 supplier despite numerous studies of microbiologically-proven bloodstream infections (BSI) in sub-Saharan Africa (SSA),2 and 3 few have sought to systematically evaluate patients against internationally defined criteria for sepsis in such settings.4 Case definitions for sepsis, severe sepsis and systemic inflammatory response syndrome (SIRS) were developed in 19925 and with refinements in 2002,6 20087 and 2013.8 The Surviving Sepsis Campaign, recommending ‘bundles’ of early, specific interventions has led to demonstrable improvements in clinical outcomes in severe sepsis in well-resourced settings.9 However, although early identification and treatment of sepsis in low-income countries have been highlighted as essential components of good clinical care by the World ABT-263 concentration Health Organisation (WHO),10 lack

of data regarding the clinical manifestations of severe sepsis from many such countries renders it problematic to derive evidence-based guidelines.11, 12 and 13 Differences in age range, spectrum of aetiology, and co-morbidities such as HIV, TB and malaria

makes extrapolation however of data from high/middle-income to low income countries unreliable. Furthermore, resource limitations are a significant constraint to implementing even simple interventions.11 This study therefore aimed to assess the risk of death among adult medical patients presenting to hospital with syndromically defined sepsis and severe sepsis in the context of a low income African setting with high HIV prevalence. Furthermore, we have investigated the impact of ART on clinical outcomes from sepsis and severe sepsis in this environment and sought to identify additional simple physiological assessments that could be used to identify high risk patients in whom interventional trials are warranted. Queen Elizabeth Central Hospital (QECH) is a 1250-bed government-funded teaching hospital providing secondary and tertiary care, free of at the point of care to the patient. QECH serves a population of approximately one million including the city of Blantyre, the surrounding townships, and outlying villages. At QECH, measurement of central venous pressure, blood gas analysis and urine output are logistically difficult and rarely performed. Vasopressors and inotropes are unavailable on the medical wards.