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Sepsis in the tropical Top End of Australia’s Northern Territory: disease burden and impact on Indigenous Australians

Joshua S Davis, Allen C Cheng, Mark McMillan, Alex B Humphrey, Dianne P Stephens and Nicholas M Anstey
Med J Aust 2011; 194 (10): 519-524.

Summary

Objective: To describe the clinical and epidemiological features of sepsis and severe sepsis in the population of the tropical Top End of the Northern Territory of Australia and compare these with published estimates for temperate Australia, the United States and Europe.

Design, setting and participants: Prospective cohort study in the major hospital for tropical NT, a region where 27% of the population are Indigenous. We screened all adult (≥ 15 years) acute hospital admissions over a 12-month period (6 May 2007 – 5 May 2008) for sepsis by standard criteria, and collected standardised clinical data.

Main outcome measures: Population-based incidence of community-onset sepsis and severe sepsis requiring intensive care unit (ICU) admission; 28-day mortality rate and microbial epidemiology.

Results: There were 1191 hospital admissions for sepsis in 1090 patients, of which 604 (50.7%) were Indigenous people; the average age was 46.7 years. The age-adjusted annual population-based incidence of sepsis was 11.8 admissions per 1000 (mortality rate, 5.4%), but for Indigenous people it was 40.8 per 1000 (mortality rate, 5.7%). For severe sepsis requiring ICU admission, the incidence was 1.3 per 1000 per year (mortality rate, 21.5%), with an Indigenous rate of 4.7 per 1000 (mortality rate, 19.3%).

Conclusions: The incidence of sepsis in the tropical NT is substantially higher than that for temperate Australia, the United States and Europe, and these differences are mainly accounted for by the high rates of sepsis in Indigenous people. The findings support strategies to improve housing and access to health services, and reduce comorbidities, alcohol and tobacco use in Indigenous Australians. The burden of sepsis in indigenous populations worldwide requires further study to guide appropriate resourcing of health care and preventive strategies.

  • Joshua S Davis1,2
  • Allen C Cheng2,3,4
  • Mark McMillan2
  • Alex B Humphrey2
  • Dianne P Stephens1
  • Nicholas M Anstey1,2

  • 1 Royal Darwin Hospital, Darwin, NT.
  • 2 Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT.
  • 3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 4 Alfred Hospital, Melbourne, VIC.


Acknowledgements: 

We would like to thank Bart Currie, John Condon, Steven Guthridge and Ric Price for advice regarding data collection and analysis; and Luke Diolosa for providing APACHE scores for patients admitted to the ICU. The study was funded by the National Health and Medical Research Council of Australia (Program Grants 290208, 496600; a Practitioner Fellowship to Nicholas Anstey, a Research Training Fellowship to Allen Cheng, and a PhD Scholarship to Joshua Davis).

Competing interests:

None identified.

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