Outcomes of patients with severe infection in Uganda according to adherence to the World Health Organization's Integrated Management of Adolescent and Adult Illness fluid resuscitation guidelines

Abstract

Purpose: We determined outcomes in hospitalized patients in Uganda with World Health Organization's Integrated Management of Adolescent and Adult Illness (IMAI) defined septic shock (IMAI-shock) or severe respiratory distress without shock (IMAI-SRD) based on whether they received recommended fluid resuscitation according to IMAI guidelines. Materials and methods: We performed a secondary analysis of a prospective cohort of adult septic patients in Uganda that included the volume of fluids patients received during the first 6 h of resuscitation. We used logistic regression to determine predictors of outcomes. Results: We evaluated 122 patients with IMAI-shock and 32 patients with IMAI-SRD. For patients with IMAIshock or IMAI-SRD, there was no difference in mortality between those that received IMAI recommended fluid volume and those that did not (30% vs 36%, p = 0.788; 22% vs 57%, p = 0.08). For patients with IMAI-shock, in-hospital mortality was associated with mid-upper arm circumference (adjusted odds ratio [aOR] 0.841, 95% confidence interval [CI] 0.722–0.979, p = 0.026) and ambulation (aOR 0.247, 95%CI 0.084–0.727, p = 0.011). We found no associations with in-hospital mortality for patients with IMAI-SRD. Conclusion: IMAI recommended fluid resuscitation was not associated with better outcomes for patients with IMAI-shock or IMAI-SRD. Further studies are needed to optimize resuscitation for patients with severe infection in resource-limited settings such as Uganda.