Sepsis in two hospitals in Rwanda: A retrospective cohort study of presentation, management, outcomes, and predictors of mortality.

PURPOSE: Few studies have assessed the presentation, management, and outcomes of sepsis in low-income countries (LICs). We sought to characterize these aspects of sepsis and to assess mortality predictors in sepsis in two referral hospitals in Rwanda. MATERIALS AND METHODS: This was a retrospective cohort study in two public academic referral hospitals in Rwanda. Data was abstracted from paper medical records of adult patients who met our criteria for sepsis. RESULTS: Of the 181 subjects who met eligibility criteria, 111 (61.3%) met our criteria for sepsis without shock and 70 (38.7%) met our criteria for septic shock. Thirty-five subjects (19.3%) were known to be HIV positive. The vast majority of septic patients (92.7%) received intravenous fluid therapy (median = 1.0 L within 8 hours), and 94.0% received antimicrobials. Vasopressors were administered to 32.0% of the cohort and 46.4% received mechanical ventilation. In-hospital mortality for all patients with sepsis was 51.4%, and it was 82.9% for those with septic shock. Baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity. CONCLUSIONS: Septic patients in two public tertiary referral hospitals in Rwanda are young (median age = 40, IQR = 29, 59) and experience high rates of mortality. Predictors of mortality included baseline clinical characteristics and HIV seropositivity status. The majority of subjects were treated with intravenous fluids and antimicrobials. Further work is needed to understand clinical and management factors that may help improve mortality in septic patients in LICs

Phytochemical and Antimicrobial Activity of Ocimum suave Against Selected Human Pathogenic Bacteria

Worldwide, the use of antibiotics is losing effectiveness due to the substantial resistance to the antimicrobial developed by many pathogenic bacteria. African populations including Rwanda, use frequently traditional medicine for primary care. This study aimed to determine the phytochemicals and the antimicrobial activity of Ocimum. suave (O. suave) against selected human pathogenic bacteria (two strains of S. aureus, P. aeruginosa, two strains of E. coli, S. pneumonia, S. pyogene, K. oxytoca, H. influenza, S. sonei). The leaf and stem extracts were prepared using maceration technique. The antimicrobial activities of extracts were evaluated using the impregnated disc and agar well diffusion methods. The tests revealed the presence of phytochemical substances such as tannins, flavonoids, saponins, steroids alkaloids and phenolics in leaves and only saponins in stem. S. aureus ATCC 43300 was the most sensitive while H. influenza was the most resistant among the microorganisms tested. Aqueous and methanolic crude extract of O. suave displayed maximum diameter of inhibition zone against bacteria (9-26.5 mm and 9-23.5 respectively) and Two-way ANOVA showed statistical significance difference between their means. T-test was used in comparison with standards antibiotics and showed that the distilled water extracts exhibited much higher activity against all tested organisms than activity of streptomycin. Combination of distilled water and methanol extracts with streptomycin revealed synergistic activity against E. coli ATCC 25922 and S. pneumonia ATCC 49618. The leaves of O. suave have a great potential antibacterial activity and should be fully explored for future treatment. Keywords: phytochemical; antimicrobial activity; Ocimum suave, Rwand