Aim and objectives: Analysis of blood cultures taken from patients attending emergency departments is an important exercise in determining the common pathogens prevalent in the region. The distribution of these infective pathogens keeps changing over time, and the rise in antimicrobial-resistant pathogens makes it difficult to routinely conduct effective empirical broad-spectrum antimicrobial therapy. This study aimed to analyse the results of blood cultures obtained from patients presenting to the Emergency Department of a Tertiary Healthcare Hospital in Mumbai and provide updated and detailed information on the distribution of causative pathogens in adult sepsis and study their antibiotic-susceptibility pattern.
Materials and methods: A hospital-based prospective cross-sectional study of 121 positive blood culture reports was conducted at the Department of Emergency Medicine, Fortis Hospital Mulund, Mumbai, which included all adult (age > 18 yrs) suspected sepsis patients arriving to the Emergency Department whose blood cultures were sent from the Emergency Department from January 2021 to December 2021.
Results: The study showed that mean age of the study cases was 59.3 years with 59.5% cases that belonged to the elderly age group with a male predominance (56.2% males–43.8% females). Overall, Gram-negative isolates were seen in 95% cases, while Gram-positive isolates were seen in only 1.7% cases. The most common organism isolated from cases with sepsis was Escherichia coli (45.5%) followed by Klebsiella (13.2%), Salmonella (10.7%), Stenotrophomonas (7.4%) and Pseudomonas (5%). Among Gram-positive organisms, Staphylococcus aureus was the most common organism isolated (1.7%). Escherichia coli isolates showed poor sensitivity towards fluoroquinolones and cephalosporins while good sensitivity towards aminoglycosides, carbapenems and combination drugs like Cefoperazone and Sulbactam and Piperacillin and Tazobactam. These findings suggest that Gram-negative organisms are the most common isolates observed in this study, with E. coli being the predominant pathogen followed by Klebsiella. High-level antimicrobial resistance was observed in sepsis cases for commonly used antimicrobials like fluoroquinolones and cephalosporins.
Angus DC, Linde-Zwirbe WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29(7):1303–1310. DOI: 10.1097/00003246-200107000-00002.
Vincent JL, Sakr Y, Sprung CL, et al. Sepsis occurrence in acutely III patients investigators. Sepsis in European intensive care units: Results of the SOAP study. Crit Care Med 2006;34(2):344–353. DOI: 10.1097/01.ccm.0000194725.48928.3a.
Tarassenko L, Hann A, Young D. Integrated monitoring and analysis for early warning of patient deterioration. Br J Anaseth 2006;97(1):64–68. DOI: 10.1093/bja/ael113.
Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: Results from a guideline-based performance improvement program. Crit Care Med 2014;42(8):1749–1755. DOI: 10.1097/CCM.0000000000000330.
Barie PS, Hydo LJ, Shou J, et al. Influence of antibiotic therapy on mortality of critical surgical illness caused or complicated by infection. Surg Infect (Larchmt) 2005;6(1):41–54. DOI: 10.1089/sur.2005.6.41.
Paul M, Shani V, Muchtar E, et al. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother 2010;54(11):4851–4863. DOI: 10.1128/AAC.00627-10.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017;43(3):304–377. DOI: 10.1007/s00134-017-4683-6.
Evans L, Rhodes A, Alhazzani W, et al. Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021. Crit Care Med 2021;49(11):1974–1982. DOI: 10.1097/CCM.0000000000005357.
Balkhy HH, El-Saed A, Alshamrani MM, et al. Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007–2016. Antimicrob Resist Infect Control 2020;9(1):21. DOI: 10.1186/s13756-020-0678-0.
Avery LM, Nicolau DP. Investigational drugs for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. Expert Opin Investig Drugs 2018;27(4):325–338. DOI: 10.1080/13543784.2018.1460354.
Zaidi AK, Thaver D, Ali SA, et al. Pathogens associated with sepsis in newborns and young infants in developing countries. Pediatr Infect Dis J 2009;28(1 Suppl):S10–S18. DOI: 10.1097/INF.0b013e3181958769.
Han BA, Kramer AM, Drake JM. Global patterns of zoonotic disease in mammals. Trends Parasitol 2016;32(7):565–577. DOI: 0.1016/j.pt.2016.04.007.
Aku FY, Akweongo P, Nyarko K, et al. Bacteriological profile and antibiotic susceptibility pattern of common isolates of neonatal sepsis, Ho Municipality, Ghana–2016. Matern Health Neonatol Perinatol 2018;4:2. DOI: 10.1186/s40748-017-0071-z.
Dong H, Cao H, Zheng H. Pathogenic bacteria distributions and drug resistance analysis in 96 cases of neonatal sepsis. BMC Pediatr 2017;17(1):44. DOI: 10.1186/s12887-017-0789-9.
Boyles TH, Davis K, Crede T, et al. Blood cultures taken from patients attending emergency departments in South Africa are an important antibiotic stewardship tool, which directly influences patient management. BMC Infect Dis 2015;15:410. DOI: 10.1186/s12879-015-1127-1.
Todi S, Chatterjee S, Sahu S, et al. Epidemiology of severe sepsis in India: A update. Crit Care 2010;14(Suppl 1):P382. DOI: 10.1186/cc8614.
Peres Bota D, Melot C, Lopes Ferreira F, et al. The Multiple Organ Dysfunction Score (MODS) versus the Sequential Organ Failure Assessment (SOFA) score in outcome prediction. Intensive Care Med 2002;28(11):1619–1624. DOI: 10.1007/s00134-002-1491-3.
Dash L, Singh LK, Murmu M, et al. Clinical profile and outcome of organ dysfunction in sepsis. Int J Res Med Sci 2018;6(6):1927–1933. DOI: 10.18203/2320-6012.ijrms20182045.
Finfer S, Bellomo R, Lipman J, et al. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med 2004;30(4):589–596. DOI: 10.1007/s00134-004-2157-0.
Chatterjee S, Bhattacharya M, Todi SK. Epidemiology of adult-population sepsis in India: A single center 5-year experience. Indian J Crit Care Med 2017;21(9):573–577. DOI: 10.4103/ijccm.IJCCM_240_17.
Kumalo A, Kassa T, Daka D, et al. Bacterial profile of adult sepsis and their antimicrobial susceptibility pattern at Jimma University specialized hospital, south West Ethiopia. Health Sci J 2016;10(2): 10–16. Available from: https://api.semanticscholar.org/.
Vendemiato AVR, von Nowakonski A, Marson FAdL, et al. Microbiological characteristics of sepsis in a University hospital. BMC Infect Dis 2015;15:58. DOI: 10.1186/s12879-015-0798-y.
Fuchs A, Tufa TB, Hörner J, et al. Clinical and microbiological characterization of sepsis and evaluation of sepsis scores. PLos One 2021;16(3):e0247646. DOI: 10.1371/journal.pone.0247646.