# Epidemiology, Management, and Outcomes of Patients Hospitalized With Community-Acquired Infection in a Resource-Limited Setting in Southeast Asia: A Prospective Observational Study

## TL;DR

This study examines sepsis and infection outcomes in hospitalized patients in rural Southeast Asia, highlighting high mortality and unique tropical pathogens.

## Contribution

The study provides new insights into sepsis epidemiology and management in a resource-limited setting in Southeast Asia.

## Key findings

- Sepsis was diagnosed in 66% of hospitalized patients with community-acquired infection.
- Sepsis-associated acute kidney injury was independently linked to higher mortality.
- Tropical infections like melioidosis and leptospirosis were notable etiologies.

## Abstract

In many resource-limited settings, hospitalization for community-acquired infection is common, but data regarding illness severity, etiology, and morbidity remain sparse.

We conducted a prospective observational study from May 2022 to August 2023 at 2 hospitals in northeast Thailand. Adults hospitalized with community-acquired infection were enrolled within 24 hours of admission and followed up to 28 days. We identified patients meeting sepsis criteria and assessed related epidemiology, management, and mortality risk factors.

Of 1445 patients screened, 940 were enrolled. The median age was 60 years and preexisting diabetes mellitus was common (42%). Sixty-six percent of patients met sepsis criteria. Blood cultures and broad-spectrum antibiotics on admission were common (both >95%), although lactate measurement was performed in 43% of patients with sepsis. In patients with sepsis, critical illness outside the intensive care unit was common on medical ward admission, including respiratory failure (33%) and shock (21%). Tropical etiologies of infection included melioidosis (8%) and leptospirosis (4%), and gram-negative organisms accounted for 81% of bacteremia. Twenty percent of patients with sepsis died by 28 days. Sepsis-associated acute kidney injury (SA-AKI) on admission was independently associated with mortality (adjusted odds ratio, 2.07; 95% CI, 1.30–3.29; P = .002), and patients with SA-AKI had worse survival (P < .001) than those without.

In rural Southeast Asia, sepsis is common among patients hospitalized with infection and associated with substantial morbidity and mortality. Distinct pathogens and broad-spectrum antibiotics are common, even in the absence of sepsis. We identified several modifiable risk factors of death, including SA-AKI, potentially influencing initial management in similar settings.