High mortality rate in intervention arm for patients with RR >40 AND SpO2 < 90%.

This study is a randomized control trial assessing the impact of a simple evidence-based protocol for the treatment severe sepsis in Zambia. The intervention protocol consists of a scheduled fluid regimen, early blood culture and antibiotics, and dopamine and blood transfusion when necessary. It is hypothesized that the protocol will significantly decrease in-hospital mortality in patients with severe sepsis.

In recent years, evidence-based protocols of bundled therapies have improved survival of severe sepsis in developed countries. However, in sub-Saharan Africa, simple therapies such as IV fluids and early antibiotics are frequently under-utilized. Furthermore, although tuberculosis is a common cause of severe sepsis in the region, accurate and timely diagnosis of tuberculosis-associated severe sepsis remains elusive.

The aims of this study are (1) To assess the impact on survival of a simple evidence-based protocol for severe sepsis, (2) To evaluate the cost of implementation for a simplified severe sepsis protocol (3) To develop a clinical diagnostic score for identifying tuberculosis in HIV positive patients with severe sepsis (4) To assess the performance of the Xpert TB/RIF rapid PCR system for diagnosing tuberculosis in HIV positive patients with severe sepsis.

Inclusion Criteria:

• Age 18 or older

• Suspected infection

• 2 or more of SIRS criteria:

  • Heart rate >90/min
  • Respiratory rate >20/min
  • Temperature >= 38° C or <= 36° C
  • White blood count > 12,000 or < 4,000/µL

• 1 or more of the following signs of end-organ dysfunction

  • Systolic blood pressure < 90 mm Hg
  • Mean arterial blood pressure (MAP) < 65 mm Hg
  • Confusion/altered mentation
  • Urine output < 0.5 mL/kg/hr
  • Creatinine increase > 0.5 mg/dL
  • Creatinine > 0.5 mg/dL above upper limit of normal
  • Platelet < 100x109/L
  • Respiratory rate > 40/min
  • Jaundice

Exclusion Criteria:

• GI bleed
• Need for urgent surgery