Epidemiology of severe infections in Latin American intensive care units - Critical Care Science (CCS)
The majority of the representative epidemiologic reports of sepsis are from developed countries; in Latin America, the clinical and epidemiological approaches to the problem have sometimes been inappropriate in terms of research design, study population, and clinical outcomes.() Cities are expanding rapidly in middle-income countries, but their supply of acute care services is unknown. Hospital bed per disease burden has been associated with gross domestic product, but ICU supply has not. Given that there are no well-recognized metrics for acute care services supply, it is not surprising that cities lack comprehensive data.() In a convenience sample of 13 ICUs from low- and middle-income countries, specialty-trained staff and standardized processes of care such as checklists were frequently missing.()
It is unlikely that in Latin America there is a lower incidence of sepsis or a better prognosis for the condition than there is in the developed countries of the world. In EPISEPSIS Colombia,() a prospective study that addressed the current status of sepsis in adult patients hospitalized in institutions of the highest level within the Colombian health system, we found that the frequency of severe sepsis and septic shock are far beyond the figures reported throughout the world. Although the mortality rates of patients who met the criteria for severe sepsis and septic shock (22% and 46%, respectively) are similar to those reported in other studies,(,) the overall 28-day mortality rate of 19% is higher than expected, according to a mean Acute Physiologic and Chronic Health Evaluation II score of 11.5 (14%). In a multicenter observational cohort study, Silva concluded that sepsis is a major public health problem in Brazilian ICUs, with an incidence density of approximately 57 per 1000 patient-days. Moreover, there was a close association between American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) categories and mortality rate.()
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The majority of the representative epidemiologic reports of sepsis are from developed countries; in Latin America, the clinical and epidemiological approaches to the problem have sometimes been inappropriate in terms of research design, study population, and clinical outcomes.() Cities are expanding rapidly in middle-income countries, but their supply of acute care services is unknown. Hospital bed per disease burden has been associated with gross domestic product, but ICU supply has not. Given that there are no well-recognized metrics for acute care services supply, it is not surprising that cities lack comprehensive data.() In a convenience sample of 13 ICUs from low- and middle-income countries, specialty-trained staff and standardized processes of care such as checklists were frequently missing.()
It is unlikely that in Latin America there is a lower incidence of sepsis or a better prognosis for the condition than there is in the developed countries of the world. In EPISEPSIS Colombia,() a prospective study that addressed the current status of sepsis in adult patients hospitalized in institutions of the highest level within the Colombian health system, we found that the frequency of severe sepsis and septic shock are far beyond the figures reported throughout the world. Although the mortality rates of patients who met the criteria for severe sepsis and septic shock (22% and 46%, respectively) are similar to those reported in other studies,(,) the overall 28-day mortality rate of 19% is higher than expected, according to a mean Acute Physiologic and Chronic Health Evaluation II score of 11.5 (14%). In a multicenter observational cohort study, Silva concluded that sepsis is a major public health problem in Brazilian ICUs, with an incidence density of approximately 57 per 1000 patient-days. Moreover, there was a close association between American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) categories and mortality rate.()
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