Gaps and Strategies for Management of Sepsis in Low-Resource Settings: Expert Consensus Statements Using a Delphi Method
Issued Date
2026-01-01
Resource Type
ISSN
00903493
eISSN
15300293
Scopus ID
2-s2.0-105035721861
Pubmed ID
41860328
Journal Title
Critical Care Medicine
Rights Holder(s)
SCOPUS
Bibliographic Citation
Critical Care Medicine (2026)
Suggested Citation
Myatra S.N., Boyer K.M., Hidalgo J.L., Maves R.C., Acharya S.P., Jacob S.T., Kortz T.B., Nadkarni V.M., Pérez Cornejo M.S., Perez-Fernandez J., Johnston C., Machado F.R., Morrow B.M., Coopersmith C.M., Kissoon N., Molyneux E., Permpikul C., Piyavechviratana K., Rhodes A., Ulisubisya M.M., Kumar V.K., Patel H., Woznica D., Akech S.O. Gaps and Strategies for Management of Sepsis in Low-Resource Settings: Expert Consensus Statements Using a Delphi Method. Critical Care Medicine (2026). doi:10.1097/CCM.0000000000007102 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116346
Title
Gaps and Strategies for Management of Sepsis in Low-Resource Settings: Expert Consensus Statements Using a Delphi Method
Author(s)
Myatra S.N.
Boyer K.M.
Hidalgo J.L.
Maves R.C.
Acharya S.P.
Jacob S.T.
Kortz T.B.
Nadkarni V.M.
Pérez Cornejo M.S.
Perez-Fernandez J.
Johnston C.
Machado F.R.
Morrow B.M.
Coopersmith C.M.
Kissoon N.
Molyneux E.
Permpikul C.
Piyavechviratana K.
Rhodes A.
Ulisubisya M.M.
Kumar V.K.
Patel H.
Woznica D.
Akech S.O.
Boyer K.M.
Hidalgo J.L.
Maves R.C.
Acharya S.P.
Jacob S.T.
Kortz T.B.
Nadkarni V.M.
Pérez Cornejo M.S.
Perez-Fernandez J.
Johnston C.
Machado F.R.
Morrow B.M.
Coopersmith C.M.
Kissoon N.
Molyneux E.
Permpikul C.
Piyavechviratana K.
Rhodes A.
Ulisubisya M.M.
Kumar V.K.
Patel H.
Woznica D.
Akech S.O.
Author's Affiliation
Universidade de São Paulo
The University of British Columbia
University of California, San Francisco
UCSF School of Medicine
University of Pennsylvania Perelman School of Medicine
University of Cape Town
Universidade Federal de São Paulo
Wake Forest University School of Medicine
Siriraj Hospital
Liverpool School of Tropical Medicine
Tata Memorial Hospital
St George's University Hospitals NHS Foundation Trust
Kamuzu University of Health Sciences
Herbert Wertheim College of Medicine
Emory Healthcare
Wellcome Trust Research Laboratories Nairobi
Phramongkutklao College of Medicine
Tribhuvan University Teaching Hospital
Society of Critical Care Medicine
Muhimbili Orthopaedic Institute
Walimu
Belize Healthcare Partners
State General Hospital
The University of British Columbia
University of California, San Francisco
UCSF School of Medicine
University of Pennsylvania Perelman School of Medicine
University of Cape Town
Universidade Federal de São Paulo
Wake Forest University School of Medicine
Siriraj Hospital
Liverpool School of Tropical Medicine
Tata Memorial Hospital
St George's University Hospitals NHS Foundation Trust
Kamuzu University of Health Sciences
Herbert Wertheim College of Medicine
Emory Healthcare
Wellcome Trust Research Laboratories Nairobi
Phramongkutklao College of Medicine
Tribhuvan University Teaching Hospital
Society of Critical Care Medicine
Muhimbili Orthopaedic Institute
Walimu
Belize Healthcare Partners
State General Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives: – Almost 80% of sepsis cases occur in low-resource settings (LRS), where limited resources impede the effective implementation of international guidelines for sepsis management. In addition, existing sepsis guidelines have not fully addressed specific issues relevant to LRS. Therefore, an international panel of 20 multiprofessional sepsis experts was convened to generate consensus on the gaps in and strategies for sepsis care in LRS. The recently developed “sepsis chain of survival” was used as a framework. Data Sources: – MEDLINE, Embase. Study Selection: – Studies selected included human studies (clinical trials, cohort, case-control, and case series) reporting clinical outcomes in patients with sepsis from LRS between January 1, 2000, and July 4, 2024. Search terms included “developing countries, ” “LMIC, ” “resource-poor settings, ” and regional terms such as Africa, Southeast Asia, and Latin America. The Delphi process involved iterative, anonymous voting by the expert panel to achieve consensus to draft clinical practice statements. Data Extraction: – A detailed literature review was conducted using the “sepsis chain of survival” as a basis, with an emphasis on sepsis prevention, detection, therapy, post-sepsis care, education, and future research priorities. A total of 8865 studies were identified and screened, with 155 included in the review. Data Synthesis: – Based on literature review, the Delphi process achieved a stable consensus for 58 of 62 (94%) of the proposed clinical practice statements after eight survey rounds. These statements offer guidance on measures to improve the prevention, early recognition and time-sensitive, comprehensive management of sepsis in LRS through the continuum of care from first response to post-sepsis care and follow-up. Conclusions: – There remains a significant lack of high-quality evidence to support improvements in sepsis care for patients in LRS. Pending new data, the clinical practice statements identified here complement the existing international guidelines for sepsis management by serving as a basis for immediate care and future research in LRS.