Causes and Outcomes of Sepsis in Southeast Asia: A Multinational Multicentre Cross-sectional Study

BACKGROUND: A better understanding of pathogens causing sepsis is important for management and antimicrobial selection. Here, we explored the causative pathogens of sepsis in Southeast Asia (SEA). METHODS: We prospectively recruited children (age≥30 days and <18 years) and adults (age≥18 years) at 13 public hospitals in Indonesia (n=3), Thailand (n=4) and Viet Nam (n=6). Hospitalised patients with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were enrolled. Blood from every patient, and nasopharyngeal swab, urine, stool and cerebrospinal fluid, if indicated, were collected for reference diagnostic tests. This study was registered with ClinicalTrials.gov, number NCT02157259. FINDINGS: From December 2013 to December 2015, 1,578 patients (763 children and 815 adults) were enrolled. Dengue viruses (n=122, 8%), Leptospira spp. (n=95, 6%), rickettsial pathogens (n=96, 6%), Escherichia coli (n=76, 5%) and influenza viruses (n=65, 4%) were commonly identified in both age groups, while Plasmodium spp. (n=12, 1%) and Salmonella enterica serovar Typhi (n=3, 0.2%) were rarely observed. Emerging pathogens identified included hantaviruses (n=28, 2%), non-typhoidal Salmonella spp (n=21, 1%), Streptococcus suis (n=18, 1%), Acinetobacter spp. (n=12, 1%), and Burkholderia pseudomallei (n=5, 0.3%). 28-day mortality was 2% in children (14/731) and 13% in adults (108/804). Severe sepsis was identified on enrolment in 27% of children (204/763) and 68% of adults (550/815), and was associated with increased mortality (adjusted odds ratio 5.3, 95% confidence interval 2.7–10.4, p<0.001). INTERPRETATION: Sepsis in SEA is caused by a wide range of known and emerging pathogens, and is associated with substantial mortality. FUNDING: National Cancer Institute (HHSN261200800001E) and National Institute of Allergy and Infectious Diseases, National Institutes of Health, and Wellcome Trust (106680/B/14/Z and 106698/B/14/Z).