Bacterial Sepsis Pathogens and Resistance Patterns in a South Asian Tertiary Care Hospital

Abstract

The aim of this study was to determine common microorganisms causing septicemia and their antimicrobial sensitivities in patients admitted to a tertiary care hospital. MethodsA cross-sectional study was conducted using clinical criteria to diagnose patients as having septicemia where blood for culture and sensitivity (CS) was sent to the laboratory of a tertiary care hospital, Rehman Medical Institute, (Peshawar), Pakistan, during 2019. All patients diagnosed with septicemia regardless of age and gender were included in the study. The blood CS report was collected after 7-14 days of inoculation. Data were recorded on structured performa and analyzed using SPSS Version 20 (IBM Corp.). ResultsA total of 176 patients, with a mean age of 2.92±1.32 years, fulfilled the criteria for sepsis with a mean age of 2.92±1.32 years. Among them, 61.9% were male and 38.1% were female. Among common bacterial isolates, Staphylococcus aureus was found in 37.5% of samples followed by skin contaminants (18.2%), methicillinresistant Staphylococcus aureus (MRSA) (14.8%), and Escherichia coli in (11.4% cases). None of the antibiotics had susceptibility of more than 60%. Susceptibility to piperacillin/tazobactam and ampicillin/sulbactam was found in 21.5% and 14.6% of the samples, respectively, while in cephalosporins, cefoxitin's susceptibility was 28.5%, whereas both ceftriaxone and cephazolin were equally effective in 19.4% cases. Furthermore, 38.9% of the samples were susceptible to ciprofloxacin and 24.3% to levofloxacin. The susceptibilities of amikacin and gentamicin in aminoglycosides were 56.3% and 47.2%, respectively, while that of imipenem and meropenem were 59.7% and 22.9%, respectively. Lastly, clindamycin had an efficacy in 42.4% of samples. ConclusionThe susceptibility of bacterial isolates in septicemia to common antibiotics was low, thus risking therapeutic failure in septic patients. Widespread resistance may be due to the excessive use along with over-thecounter availability of antibiotics, which therefore requires regulation as it is an alarming situation.

Sepsis Management in Southeast Asia: A Review and Clinical Experience

“…A study conducted in Nepal reported that Gram-negative organisms were non-resistant to chloramphenicol and tigecycline showed [16]. An Indian study demonstrated that the majority of 33 Klebsiella pneumoniae and E. coli isolates were non-resistant to meropenem, amikacin, chloramphenicol and ciprofloxacin [7]. Chloramphenicol is a safe alternative.…”

“…Another study reported that colistin-resistant Klebsiella isolate had mutations in the mgrB, PhoP and PhoQ genes [45]. Pakistani and East Indian studies have reported colistin resistance due to the high use of meropenem and colistin in patients with sepsis [7,41]. Another study demonstrated that the prevalence of colistin resistance among Escherichia coli and Klebsiella pneumoniae isolates was very high [46].…”

“…A recent study reports that Escherichia coli, Staphylococcus aureus and Klebsiella species are the most commonly reported pathogens in early-onset sepsis [EOS], which occurs in the first 72 h of life, whereas Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae are the most commonly reported in late-onset sepsis [LOS], which occurs beyond 72 h of life in the developing countries of South Asia, Central Asia, East Asia, Pacific, Africa, Middle East and Latin America [6]. Another study found Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli in sepsis patients in Pakistan [7].…”

“…The conventional treatment for sepsis involves antibiotics, plasma, oxygen and other blood products to help with thromboembolic complications, and vasoactive medications and intravenous fluids for stabilizing the blood circulation and maintaining blood pressure [9]. There have been various sepsis studies in the Southeast Asia including Bangladesh [10,11], India [11][12][13], Indonesia [14,15], Nepal [6,11,16,17], Pakistan [7], Sri Lanka [18,19], Thailand [14,20] and Vietnam [14,21]. Appropriate management of sepsis is required, especially in Southeast Asian countries where the mortality rate is high [9].…”

Increase Mortality Rate in Sepsis Patients with qSOFA Score Greater than Two

“…2 Clinicians have developed various screening and prediction tools to screen high-risk cases or patients with presumably poor outcomes incorporating various clinical and laboratory parameters. 3,4 qSOFA score, SOFA score, and SIRS have been used in routine by treating teams to categorize the patients according to disease severity. 5,6 Some work has been published in recent years regarding the role of various scores in predicting mortality in patients with sepsis.…”