Management of Septic Shock in surgical patients in Jimma University Medical Centre April 2023- 0ctober 2023

Abstract

Background: Sepsis and septic shock are major healthcare issues, affecting millions of people worldwide each year and killing between one in three and one in six of those with sepsis/septic shock. According to Sepsis-3 criteria, sepsis is a “life-threatening organ dysfunction caused by a dysregulated host response to infection”. Septic shock “is a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone. Objective: to assess the management of septic shock among surgical patients at Jimma University Medical Centre April 2023- 0ctober 2023. Methods: This prospective observational study was conducted at JUMC, located in Jimma town in southwest Ethiopia. The study period was from April 2023 to October 2023. All adult surgical patients who presented with/developed septic shock at Jimma University Medical Centre were included. Results: There were a total of 61 patients during the study. The age group most affected was 15 to 39 years old, the median age of patients was 45 (IQR, 40-60) years, and 77% (n=47) of the patients were male. The most frequent source of infection in this study was community-acquired infection 83.3% (n=49). The most common focus of sepsis was intra-abdominal infection of the digestive system 82% (n = 50). Regarding management, measurement of lactate levels and blood cultures before administering antibiotics was not done in all patients. Source control surgery was performed in 52.5% (n = 32) of patients after developing septic shock, and 84.4% (n = 27) of surgeries were performed within 24 hours. The 30-day mortality rate was 49 (80.3%) with an ICU mortality rate of 78.94%. The median length of stay in the intensive care unit (ICU) was 3 (IQR, 1–5) days, and the median length of hospital stay was 6 (IQR, 2–15) days. Discussion: There was poor compliance with Surviving Sepsis Campaign (SSC) 1-hour bundle, The 30 days mortality rate was high in this study, with hospital mortality of 80.1% and an ICU mortality rate of 78.94%, a study in Turkey also showed similar mortality of septic shock is 75 % according to SEPSIS-III definition and 70.4 % according to SEPSIS I. Sub-Saharan Africa found to have a higher mortality rate regardless of using standard guidelines compared with usual care. Conclusion: The mortality rate in this study was higher compared to studies done in high income and low-income countries. There was poor adherence and compliance to SSC (the 1-hour bundle). The hospital and the ICU length of stay was less compared to studies done in high income countries.