Sepsis: Causes, Adherence to Guidelines and Outcomes at a Tertiary Care Hospital

Abstract

Background: Sepsis is a major health concern that causes significant morbidity and mortality worldwide. Sepsis is treatable, and timely implementation of targeted interventions improves outcomes. Objective: To assess the cause of sepsis, the adherence to sepsis guidelines and the resultant outcomes, in a tertiary care hospital of a resource poor area. Methodology: This descriptive observational study included 180 adult patients diagnosed with sepsis. Demographic characteristics, comorbidities, infection source, microbiological (cultures) tests, organ dysfunction, guideline adherence and clinical outcomes were recorded. Adherence was assessed for key components including lactate measurement, blood cultures before antibiotics, timely broad-spectrum antibiotics use, intravenous fluids, vasopressors, reassessment, and source control. Multivariable logistic regression was used to identify predictors of in-hospital mortality. Results: The mean age was 56.8±16.2 years, and 60% were male. Respiratory tract infection was the most common source of sepsis (37.8%), followed by urinary tract infection (23.9%) and intra-abdominal infection (16.1%). Complete early sepsis bundle adherence was achieved in 50.6% of patients. Mortality was significantly lower among patients receiving guideline bundle-adherent care than among non-adherent patients (18.7% vs. 37.1%, p=0.006), while recovery was higher (81.3% vs. 62.9%, p=0.006). Mean hospital stay was also shorter with adherence (8.6±4.1 vs. 11.3±5.6 days, p<0.001). Independent predictors of mortality included age ≥65 years (aOR 2.18), septic shock (aOR 4.72), acute kidney injury (aOR 2.84), mechanical ventilation (aOR 3.56), and antibiotic delay >1 hour (aOR 2.31). Complete bundle adherence was independently protective (aOR 0.42, p=0.019). Conclusion: The leading cause of sepsis was respiratory infections, while complete adherence to recommended sepsis management guidelines was achieved in only about half of patients. When comparing outcomes between guideline-adherent cases and non-adherent cases, the guideline-adherent care was associated with lower mortality, fewer complications, and shorter hospitalization, emphasizing the importance of timely implementation of sepsis management guidelines.