Pattern of Sepsis in General Surgical Wards at Kenyatta National Hospital

Abstract

Sepsis is defined as the presence of systemic inflammatory response syndrome with evidence of infection. In the absence of intervention, sepsis can lead to organ dysfunction which is a major cause of surgical mortality and morbidity. In our setting, the prevalence, presentation and outcome of surgical sepsis is unknown. Objective This study sought to establish the pattern of sepsis in general surgical wards of Kenyatta National Hospital (KNH). Methodology A longitudinal cohort study was carried out using consecutive non-random sampling of patients in the general surgical wards of KNH. Those with abnormalities in vital signs and abnormalities in white cell counts were assessed for presence of infection. Any intervention, duration of hospitalization and outcomes were noted. Results The study recruited four hundred and three patients admitted to the surgical wards. Sepsis was present in 16.1% (n=65), 40.1% of whom were managed for emergency conditions. Of the patients who had infection diagnosed at the time of surgery, 29.2% involved soft tissue. Fluids were administered to 81.5% of patients, and cephalosporins were the most commonly prescribed drugs. Majority of patients with sepsis were discharged within fourteen days of admission. The case fatality rate was 3.1%. Conclusion Sepsis in surgical patients at KNH is more likely to arise in young male patients with emergency conditions affecting the abdomen or soft tissue. There is currently no documented protocol for management of sepsis in surgical patients. As such, teams involved in the management should have a high index of suspicion for the diagnosis and improve outcomes by paying close attention to fluid therapy, antimicrobial treatment and early source control of infection. Further research on the subject will enable personalised, timely and appropriate therapy for each patient.