WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language.
The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs

Neonatal Septicaemia in Sub-Saharan Africa: A Protocol for Systematic Review and Meta-analysis

Background: The morbidity and mortality from neonatal septicaemia (NNS) in low-middle income country remain high at the background of strained health care delivery system.The burden, pooled risks and outcomes of NNS are largely unknown. We aimed to produce a protocol for synthesizing evidence from available data for neonatal septicaemia in sub-Saharan Africa.

Methods: We developed a search strategy using MeSH, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only Observational studies retrievable in the English Language will be included. The primary measurable outcome is the proportion of neonatal with septicaemia while secondary outcomes include proportion of bacterial isolates and their antibiogram, risk factors for NNS, in hospital mortality, length of hospital stay, frequency of necrotizing enterocolitis and other sequel . All identified studies will be screened based on the inclusion criteria. Data will be deduplicated in Endnote version 9, before exporting to Rayyan QCRI for screening. Extractable data will include first author’s name and year of publication, the country and regions in sub-Saharan Africa, total neonatal admissions, number with sepsis, the sample size, bacterial isolates, antibiogram, in-hospital mortality, length of hospital stay and frequency of necrotizing enterocolitis.

All studies will be assessed for methodological, clinical and statistical heterogeneity. The NIH Quality assessment tool for observational studies and the Cochrane tool of risk of bias will be used to assess for the strength of evidence. Publication bias will be assessed using the funnel plot.

Discussion: Results will be presented as the prevalence, standard error and confidence interval of newborns with neonatal septicaemia in sub-Saharan Africa. Subgroup analysis using categorical data such as risk factors, bacterial isolates, antibiogram and outcomes of neonatal septicaemia will also be reported. A cumulative meta-analysis will be done to assess the time trend of the risk factors, pathogens and antibiogram.The CMA version 3 will be used for statistical analysis. Results will be presented in forest plots.

Evaluation of a digital triage platform in Uganda: A quality improvement initiative to reduce the time to antibiotic administration

Background
Sepsis is the leading cause of death in children under five in low- and middle-income countries. The rapid identification of the sickest children and timely antibiotic administration may improve outcomes. We developed and implemented a digital triage platform to rapidly identify critically ill children to facilitate timely intravenous antibiotic administration.

Objective
This quality improvement initiative sought to reduce the time to antibiotic administration at a dedicated children’s hospital outpatient department in Mbarara, Uganda.

Intervention and study design
The digital platform consisted of a mobile application that collects clinical signs, symptoms, and vital signs to prioritize children through a combination of emergency triggers and predictive risk algorithms. A computer-based dashboard enabled the prioritization of children by displaying an overview of all children and their triage categories. We evaluated the impact of the digital triage platform over an 11-week pre-implementation phase and an 11-week post-implementation phase. The time from the end of triage to antibiotic administration was compared to evaluate the quality improvement initiative.

Results
There was a difference of -11 minutes (95% CI, -16.0 to -6.0; p < 0.001; Mann-Whitney U test) in time to antibiotics, from 51 minutes (IQR, 27.0–94.0) pre-implementation to 44 minutes (IQR, 19.0–74.0) post-implementation. Children prioritized as emergency received the greatest time benefit (-34 minutes; 95% CI, -9.0 to -58.0; p < 0.001; Mann-Whitney U test). The proportion of children who waited more than an hour until antibiotics decreased by 21.4% (p = 0.007). Conclusion A data-driven patient prioritization and continuous feedback for healthcare workers enabled by a digital triage platform led to expedited antibiotic therapy for critically ill children with sepsis. This platform may have a more significant impact in facilities without existing triage processes and prioritization of treatments, as is commonly encountered in low resource settings.

The global burden of sepsis: barriers and potential solutions.

Sepsis is a major contributor to the global burden of disease. The majority of sepsis cases and deaths are estimated to occur in low and middle-income countries. Barriers to reducing the global burden of sepsis include difficulty quantifying attributable morbidity and mortality, low awareness, poverty and health inequity, and under-resourced and low-resilience public health and acute health care delivery systems. Important differences in the populations at risk, infecting pathogens, and clinical capacity to manage sepsis in high and low-resource settings necessitate context-specific approaches to this significant problem. We review these challenges and propose strategies to overcome them. These strategies include strengthening health systems, accurately identifying and quantifying sepsis cases, conducting inclusive research, establishing data-driven and context-specific management guidelines, promoting creative clinical interventions, and advocacy.