Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future


Marcus J. Schultz, Mahidol University
Martin W. Dunser, University College of London Hospital
Arjen M. Dondorp, Mahidol University
Neill K. J. Adhikari, Sunnybrook Health Sciences Centre and University of Toronto
Shivakumar Iyer, Bharati Vidyapeeth Deemed University Medical College
Arthur Kwizera, Mulago National Referral Hospital
Yoel Lubell, Academic Medical Center and University of Amsterdam
Alfred Papali, University of Maryland School of Medicine
Luigi Pisani, Mahidol University
Beth D. Riviello, Beth Israel Deaconess Medical Center and Harvard Medical School
Derek C. Angus, University of Pittsburgh
Luciano C. Azevedo, Hospital Sirio-Libanes
Tim Baker, Karolinska Institute
Janet V. Diaz, California Pacific Medical Center
Emir Festic, Mayo Clinic
Rashan Haniffa, Mahidol University
Randeep Jawa, Stony Brook University Medical Center
Shevin T. Jacob, University of Washington
Niranjan Kissoon, British Columbia Children’s Hospital
Rakesh Lodha, All India Institute of Medical Science
Ignacio Martin-Loeches, St. James’s University Hospital
Ganbold Lundeg, Mongolian National University of Medical Sciences
David Misango, Aga Khan UniversityFollow
Mervyn Mer, Johannesburg Hospital and University of the Witwatersrand
Sanjib Mohanty, Ispat General Hospital
Srinivas Murthy, British Columbia Children’s Hospital
Ndidiamaka Musa, Seattle Children’s Hospital and University of Washington
Jane Nakibuuka, Mulago National Referral Hospital
Ary Serpa Neto, Academic Medical Center and University of Amsterdam
Mai Nguyen Thi Hoang, Oxford University Clinical Research Unit
Binh Nguyen Thien, Trung Vuong Hospital
Rajyabardhan Pattnaik, Ispat General Hospital
Jason Phua, National University Hospital
Jacobus Preller, Cambridge University Hospitals NHS Foundation Trust
Pedro Povoa, New University of Lisbon and Hospital de Sao Francisco Xavier
Suchitra Ranjit, Appolo Hospitals
Daniel Talmor, Beth Israel Deaconess Medical Center and Harvard Medical School
Jonarthan Thevanayagam, Mzuzu Central Hospital
C. Louise Thwaites, University of Oxford

Document Type



Anaesthesiology (East Africa)


Background: Sepsis is a major reason for intensive care unit (ICU) admission, also in resource-poor settings. ICUs in low- and middle-income countries (LMICs) face many challenges that could affect patient outcome.

Aim: To describe differences between resource-poor and resource-rich settings regarding the epidemiology, pathophysiology, economics and research aspects of sepsis. We restricted this manuscript to the ICU setting even knowing that many sepsis patients in LMICs are treated outside an ICU.

Findings: Although many bacterial pathogens causing sepsis in LMICs are similar to those in high-income countries, resistance patterns to antimicrobial drugs can be very different; in addition, causes of sepsis in LMICs often include tropical diseases in which direct damaging effects of pathogens and their products can sometimes be more important than the response of the host. There are substantial and persisting differences in ICU capacities around the world; not surprisingly the lowest capacities are found in LMICs, but with important heterogeneity within individual LMICs. Although many aspects of sepsis management developed in rich countries are applicable in LMICs, implementation requires strong consideration of cost implications and the important differences in resources.

Conclusions: Addressing both disease-specific and setting-specific factors is important to improve performance of ICUs in LMICs. Although critical care for severe sepsis is likely cost-effective in LMIC setting, more detailed evaluation at both at a macro- and micro-economy level is necessary. Sepsis management in resource-limited settings is a largely unexplored frontier with important opportunities for research, training, and other initiatives for improvement.

Publication (Name of Journal)

Intensive Care Medicine