Sepsis Protocol−Driven Care Worsens Prognosis in HIV-Positive Patients in Zambia

In theory, sepsis protocols streamline early treatment of desperately ill patients so that no important steps in care are delayed or forgotten. In practice, these protocols sometimes work less well than intended. In this study from Zambia, 212 adults (≈90% HIV-positive) who presented with evidence of sepsis (i.e., hypotension, suspected infection, and ≥2 systemic inflammatory response syndrome [SIRS] criteria) to an emergency room were randomized to care specified by an accepted sepsis protocol or to usual care. Those assigned to protocol-driven care received fluids (4 L of crystalloid solution administered within 6 hours of enrollment, unless clinical evidence of fluid overload developed), dopamine infusions if blood pressure did not respo…