“Everyone needs to know their role”- A needs assessment of sepsis care at a referral hospital in western Kenya

Sepsis and septic shock disproportionately affect individuals in low-and middle-income countries (LMICs), particularly in sub-Saharan Africa. Yet, due to a paucity of data describing sepsis care and outcomes in LMICs, existing international treatment guidelines are not broadly applicable. Little is known about the current state of sepsis clinical management within LMIC settings. We aimed to gain perspectives on current care practices for sepsis from healthcare workers and identify potential gaps for further intervention within a large referral hospital in Kenya. This needs assessment was performed at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, is one of two referral hospitals in the country. Twenty-one semi-structured, individual interviews with general medicine providers at MTRH were conducted in January 2023. Interviewees included medical students, medical officers, clinical officers, nurses, pharmacists, registrars, and consultants. Interviews were performed in English, audio-recorded, and transcribed. Two independent investigators coded and thematically analyzed the data. Five major themes and twelve subthemes emerged from the data. The themes were challenges in laboratory investigations, inconsistent microbiology data, antibiotic use, changes in practice for patients living with HIV, and limited ICU capacity. The emerging themes in our data describe a challenging environment for treating sepsis. Providers face difficulty in choosing effective empiric antibiotic regimens in a setting with high rates of antimicrobial resistance. Inconsistent microbiology data and limited ICU capacity can add to the challenge of providing targeted and supportive care. These themes provide a framework for further intervention to improve outcomes.

脓毒症（sepsis）与感染性休克（septic shock）对低收入和中等收入国家（low-and middle-income countries, LMICs）人群的疾病负担尤为沉重，尤以撒哈拉以南非洲地区为甚。然而，由于目前缺乏针对低收入和中等收入国家脓毒症诊疗现状与转归的相关数据，现有的国际治疗指南难以广泛适用。学界对低收入和中等收入国家环境下脓毒症临床诊疗的真实现状仍知之甚少。本研究旨在通过肯尼亚某大型转诊医院的医护人员视角，了解当地脓毒症的现行诊疗实践，并识别可开展后续干预的潜在短板。本次需求评估在肯尼亚埃尔多雷特的莫伊教学与转诊医院（Moi Teaching and Referral Hospital, MTRH）开展，该院为肯尼亚仅有的两家转诊医院之一。研究于2023年1月对该医院的全科医疗从业者开展了21项半结构化个人访谈。受访对象涵盖医学生、医官、临床专员、护士、药师、住院医师及专科医师。访谈以英语开展，全程录音并转录为书面文本。由两名独立研究者对访谈数据进行编码与主题分析。本次分析共提炼出5个核心主题与12个子主题，分别为实验室检测面临的诸多挑战、微生物学检测结果不一致、抗菌药物使用现状、艾滋病病毒（Human Immunodeficiency Virus, HIV）感染者诊疗实践的调整，以及重症监护室（Intensive Care Unit, ICU）资源有限。上述主题清晰展现了当地脓毒症诊疗所面临的复杂环境：当地抗菌药物耐药率居高不下，医护人员难以选择有效的经验性抗菌药物治疗方案；微生物学检测结果不一致与重症监护室资源有限，进一步加大了为患者提供针对性治疗与支持性照护的难度。上述主题为后续开展改善患者诊疗转归的干预措施提供了清晰的分析框架。