{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:50:33Z","timestamp":1792799433053,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"H2020 Marie Sk\u0142odowska-Curie Innovative Training Network European Sepsis Academy"},{"DOI":"10.13039\/100019305","name":"Manipal Academy of Higher Education","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019305","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Our study addresses the sepsis research gap in lower- and middle-income countries, notably India. Here, we investigate community-acquired sepsis comprehensively and explore the impact of tropical microbiology on etiology and outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>MARS-India was a prospective observational study from December 2018 to September 2022 in a tertiary-care hospital in South India. Adult patients within 24 hours of intensive care unit (ICU) admission meeting the Sepsis-3 definition were enrolled, with 6 months of follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>More than 4000 patients were screened on ICU admission, with 1000 unique patients meeting the inclusion criteria. Median age was 55 (interquartile range, 44\u201365) years, with a male preponderance (66%). Almost half the cohort resided in villages (46.5%) and 74.6% worked in the primary sector. Mortality in-hospital was 24.1%. Overall, about 54% had confirmed microbiological diagnosis and &amp;gt;18% had a viral cause of sepsis. Surprisingly, we identified leptospirosis (10.6%), scrub typhus (4.1%), dengue (3.7%), and Kyasanur forest disease (1.6%) as notable causes of sepsis. All of these infections showed seasonal variation around the monsoon. In community-acquired infections, we observed substantial resistance to third-generation cephalosporins and carbapenems.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In India, sepsis disproportionally affects a younger and lower-socioeconomic demographic, yielding high mortality. Tropical and viral sepsis carry a significant burden. Analyzing local data, we pinpoint priorities for public health and resources, offering valuable insights for global sepsis research.<\/jats:p>\n                  <jats:p>Clinical Trials Registration. NCT03727243.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae486","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T15:12:26Z","timestamp":1727795546000},"page":"101-107","source":"Crossref","is-referenced-by-count":14,"title":["Unraveling Sepsis Epidemiology in a Low- and Middle-Income Intensive Care Setting Reveals the Alarming Burden of Tropical Infections and Antimicrobial Resistance: A Prospective Observational Study (MARS-India)"],"prefix":"10.1093","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0604-6344","authenticated-orcid":false,"given":"Harjeet S","family":"Virk","sequence":"first","affiliation":[{"name":"Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]},{"name":"Department of Microbiology, Queen Alexandra Hospital, Portsmouth Hospitals University National Health Service Trust , Portsmouth ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9393-0715","authenticated-orcid":false,"given":"Jason J","family":"Biemond","sequence":"additional","affiliation":[{"name":"Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6926-553X","authenticated-orcid":false,"given":"Venkat A","family":"Earny","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]},{"name":"Center for Emerging and Tropical Diseases (CETD), Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumi","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]},{"name":"Center for Emerging and Tropical Diseases (CETD), Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roos I","family":"Fr\u00f6lke","sequence":"additional","affiliation":[{"name":"Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saachi M","family":"Khanna","sequence":"additional","affiliation":[{"name":"Mother and Baby Unit, Hellesdon Hospital (Norfolk and Suffolk NHS Foundation Trust) , Norwich ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5255-6148","authenticated-orcid":false,"given":"Vishal","family":"Shanbhag","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5635-5332","authenticated-orcid":false,"given":"Shwethapriya","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raviraj V","family":"Acharya","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6437-8756","authenticated-orcid":false,"given":"Jayaraj M","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandana K","family":"Eshwara","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]},{"name":"Center for Emerging and Tropical Diseases (CETD), Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5546-5353","authenticated-orcid":false,"given":"Muralidhar D","family":"Varma","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education , Manipal 576104, Karnataka ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9199-5079","authenticated-orcid":false,"given":"Tom","family":"van der Poll","sequence":"additional","affiliation":[{"name":"Center for Experimental and Molecular Medicine, Amsterdam University Medical Center, University of Amsterdam , Amsterdam ,","place":["The Netherlands"]},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam , Amsterdam ,","place":["The 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