Abstract Background In many resource-limited settings, hospitalization for community-acquired infection is common, but data regarding illness severity, etiology and morbidity remain sparse. Methods We conducted a prospective, observational study from May 2022-August 2023 at two hospitals in northeast Thailand. Adults hospitalized with community-acquired infection were enrolled within 24 hours of admission and followed up to 28 days. We identified patients meeting sepsis criteria and assessed related epidemiology, management, and mortality risk factors. Results Of 1445 patients screened, 940 were enrolled. The median age was 60 years and pre-existing diabetes mellitus was common (42%). Sixty-six percent of patients met sepsis criteria. Blood cultures and broad-spectrum antibiotics on admission were common (both 95%), though lactate measurement was performed in 43% of sepsis patients. In patients with sepsis, critical illness outside the ICU was common on medical ward admission including respiratory failure (33%) and shock (21%). Tropical etiologies of infection included melioidosis (8%) and leptospirosis (4%), and Gram-negative organisms accounted for 81% of bacteremia. Twenty percent of sepsis patients died by 28-days. Sepsis-associated acute kidney injury (SA-AKI) on admission was independently associated with mortality (adjusted odds ratio 2.07; 95% confidence interval 1.30-3.29; P = 0.002), and patients with SA-AKI had worse survival (P 0.001) than those without. Conclusions In rural Southeast Asia, sepsis is common amongst patients hospitalized with infection and associated with substantial morbidity and mortality. Distinct pathogens and broad-spectrum antibiotics are common, even in the absence of sepsis. We identified several modifiable risk factors of death, including SA-AKI, potentially influencing initial management in similar settings.
Phunpang et al. (Sat,) studied this question.