The Global Burden of Sepsis: Barriers and Potential Solutions

Kristina E. Rudd; Niranjan Kissoon; Direk Limmathurotsakul; Sotharith Bory; Birungi Mutahunga; Christopher W. Seymour; Derek C. Angus; T. Eoin West


Crit Care. 2018;22(232) 

In This Article


Sepsis, a syndrome of dysregulated host response to infection leading to life-threatening organ dysfunction, is a substantial health burden worldwide. More than 19 million sepsis (formerly severe sepsis) cases and 5 million sepsis-related deaths are estimated to occur annually—the majority in low and middle-income countries (LMICs).[1] There is tremendous range in the capacity of public health and acute health care delivery systems across and within LMICs. Here, we target the challenge of sepsis in low-resource settings. These low-resource settings are more prevalent in, although not exclusively confined to, LMICs. There is heterogeneity among these low-resource areas, including important regional, political, and economic differences. Still, these regions are frequently plagued by low-resilience health systems and are home to people with limited access to health care.

While there are some published population-level estimates of sepsis epidemiology in high-income countries (HICs), the methods and results of these studies are highly variable.[2–4] In contrast, the burden in LMICs remains decidedly understudied.[1,5] Also, while outcomes of septic patients in HICs have improved in recent decades,[2,6] there is little evidence to support a similar trend in LMICs. Many barriers exist to reducing the global burden of sepsis, particularly in low-resource settings. Here, we review these hurdles and outline an integrated strategy to overcome them. This review primarily targets public health policymakers and funders as well as critical care and acute health care system leaders working in low-resource settings. While extensive examination of every facet of sepsis prevention, identification, and management is prohibitive, selected elements represent themes in the scientific literature and included references serve as examples of these themes rather than statements meant to represent all low-resource settings or the entire body of available evidence.