Open Access Correspondence

Integrating sepsis management recommendations into clinical care guidelines for district hospitals in resource-limited settings: the necessity to augment new guidelines with future research

Shevin T Jacob1*, Matthew Lim2, Patrick Banura3, Satish Bhagwanjee4, Julian Bion5, Allen C Cheng6, Hillary Cohen7, Jeremy Farrar8, Sandy Gove9, Philip Hopewell10, Christopher C Moore11, Cathy Roth12 and T Eoin West1

Author affiliations

1 International Respiratory and Severe Illness Center (INTERSECT), Department of Medicine, University of Washington, 325 9th Ave, Box 359927, Seattle, WA, 98104, USA

2 Department of Health and Human Services, Office of Global Affairs, 200 Independence Ave SW, Washington, DC, 20201, USA

3 Community Health Department, Masaka Regional Referral Hospital, Masaka, Uganda

4 Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, BB-1469, Box 356540, Seattle, WA, 98195, USA

5 University Department Anaesthesia & Intensive Care Medicine, N5, Queen Elizabeth Hospital (old site), Edgbaston, Birmingham, B15, 2TH, UK

6 Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia

7 Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA

8 The Hospital for Tropical Diseases, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam

9 IMAI-IMCI Alliance, San Francisco, CA, USA

10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA

11 Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, PO Box 801340, Charlottesville, VA, 22908, USA

12 Health Security and Environment Department, World Health Organization, 20 20 Avenue Appia, 1211, Geneva, 27, Switzerland

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Citation and License

BMC Medicine 2013, 11:107  doi:10.1186/1741-7015-11-107

Published: 18 April 2013


Several factors contribute to the high mortality attributed to severe infections in resource-limited settings. While improvements in survival and processes of care have been made in high-income settings among patients with severe conditions, such as sepsis, guidelines necessary for achieving these improvements may lack applicability or have not been tested in resource-limited settings. The World Health Organization’s recent publication of the Integrated Management of Adolescent and Adult Illness District Clinician Manual provides details on how to optimize management of severely ill, hospitalized patients in such settings, including specific guidance on the management of patients with septic shock and respiratory failure without shock. This manuscript provides the context, process and underpinnings of these sepsis guidelines. In light of the current deficits in care and the limitations associated with these guidelines, the authors propose implementing these standardized best practice guidelines while using them as a foundation for sepsis research undertaken in, and directly relevant to, resource-limited settings.

Sepsis; Resource-limited setting; Severe illness; Guidelines