• Andrew Li, Lowell Ling, Hanyu Qin, Yaseen M Arabi, Sheila Nainan Myatra, Moritoki Egi, Je Hyeong Kim, Mohd Basri Mat Nor, Do Ngoc Son, Wen-Feng Fang, Bambang Wahyuprajitno, Madiha Hashmi, Mohammad Omar Faruq, Boonsong Patjanasoontorn, Maher Jaffer Al Bahrani, Babu Raja Shrestha, Ujma Shrestha, Khalid Mahmood Khan Nafees, Kyi Kyi Sann, PaloJose Emmanuel MJEMAcute and Critical Care Institute, The Medical City, Pasig City, Philippines., Naranpurev Mendsaikhan, Aidos Konkayev, Khamsay Detleuxay, Yiong Huak Chan, Bin Du, Jigeeshu Vasishtha Divatia, Younsuck Koh, Charles D Gomersall, and Jason Phua.
• Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.
• Am. J. Respir. Crit. Care Med. 2022 Nov 1; 206 (9): 110711161107-1116.

AbstractRationale: Directly comparative data on sepsis epidemiology and sepsis bundle implementation in countries of differing national wealth remain sparse. Objectives: To evaluate across countries/regions of differing income status in Asia 1) the prevalence, causes, and outcomes of sepsis as a reason for ICU admission and 2) sepsis bundle (antibiotic administration, blood culture, and lactate measurement) compliance and its association with hospital mortality. Methods: A prospective point prevalence study was conducted among 386 adult ICUs from 22 Asian countries/regions. Adult ICU participants admitted for sepsis on four separate days (representing the seasons of 2019) were recruited. Measurements and Main Results: The overall prevalence of sepsis in ICUs was 22.4% (20.9%, 24.5%, and 21.3% in low-income countries/regions [LICs]/lower middle-income countries/regions [LMICs], upper middle-income countries/regions, and high-income countries/regions [HICs], respectively; P < 0.001). Patients were younger and had lower severity of illness in LICs/LMICs. Hospital mortality was 32.6% and marginally significantly higher in LICs/LMICs than HICs on multivariable generalized mixed model analysis (adjusted odds ratio, 1.84; 95% confidence interval, 1.00-3.37; P = 0.049). Sepsis bundle compliance was 21.5% at 1 hour (26.0%, 22.1%, and 16.2% in LICs/LMICs, upper middle-income countries/regions, and HICs, respectively; P < 0.001) and 36.6% at 3 hours (39.3%, 32.8%, and 38.5%, respectively; P = 0.001). Delaying antibiotic administration beyond 3 hours was the only element independently associated with increased mortality (adjusted odds ratio, 2.53; 95% confidence interval, 2.07-3.08; P < 0.001). Conclusions: Sepsis is a common cause of admission to Asian ICUs. Mortality remains high and is higher in LICs/LMICs after controlling for confounders. Sepsis bundle compliance remains low. Delaying antibiotic administration beyond 3 hours from diagnosis is associated with increased mortality. Clinical trial registered with www.ctri.nic.in (CTRI/2019/01/016898).

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