Clinico-microbiological profile and outcomes of nosocomial sepsis in an Indian tertiary care hospital – a prospective cohort study

Abstract

Background: Nosocomial infections are linked to rising morbidity and mortality worldwide. We sought to investigate the pattern of nosocomial sepsis, device usage, risk factors for mortality and the antimicrobial resistance pattern of the causative organisms in medical intensive care units (ICUs) in an Indian tertiary care hospital. Methods: We conducted a single-centre based prospective cohort study in four medical ICUs and patients who developed features of sepsis 48 hours after admission to the ICUs were included. Patients' demographics, indwelling device usage, microbiological culture reports, drug resistance patterns and the outcomes were recorded. The Acute Physiology and Chronic Health Evaluation (APACHE) III score and the relative risk of variables contributing towards non recovery were calculated. Results: Pneumonia (49%) was the commonest nosocomial infection resulting in sepsis, followed by urosepsis (21.8%), bloodstream infection (BSI) (10.3%) and catheter-related bloodstream infection (CRBSI) (5%). Sixty three percent of the Acinetobacter baumannii and 64.4% of the Pseudomonas aeruginosa were multidrug-resistant (MDR). Seventy percent of the Klebsiella pneumoniae were extended spectrum beta-lactamase producers and 7.4% were resistant to carbapenems. Forty three percent of the Staphylococcus aureus were methicillin-resistant S. aureus. Resistance to carbapenems was 35.2% in this study. High APACHE III scores (P 5 0.006 by unpaired t-test) and chronic kidney disease (P 5 0.023) were significantly associated with non-recovery. Conclusions: A high degree of multidrug resistance was observed among both Gram-positive and -negative organisms in nosocomial sepsis patients. Carbapenem resistance was a common occurrence. Chronic kidney disease and high APACHE III scores were significantly associated with non-recovery. Male gender and sepsis leading to cardiovascular failure were the independent predictors of mortality.

An overview of healthcare-associated infections in a tertiary care hospital in Egypt

“…Whilst a study in Ethiopia, reported that S. aureus was the most frequently detected pathogen in SSI followed by E. coli [ 30 ]. The major pathogen causing CAUTI was E. coli, which is in concordance with results from medical and surgical ICUs in Turkey and India [ 23 , 31 ]. The most frequent pathogens causing burn infection were Pseudomonas spp.…”

Hospital Acquired Bloodstream Infection by Multi Drug Resistant Organisms-Alarming and Challenging Issue in the Intensive Care Units at Present Era

“…In this study,Gram-negative bacteria predominated (66%), which is consistent with the previous research 5 . Commonly isolated GNBs were Klebsiella pneumoniae, E. coli and Acinetobacter baumanni complex,which is similar to other ICU studies in southern India 16,12 . Klebsiella pneumoniae and Acinetobacter baumanni were the common organisms isolated in VAP associated bacteremia.…”

Comparative Study of Urosepsis-Associated <i>Escherichia coli</i> in Tertiary Care University Hospital in the Central Region of Japan from 2008 to 2011

“…In previous study, the following are high-risk factors for urosepsis: Old age, female gender, diabetes, immunosuppression (organ transplantation), use of chemotherapy or steroids, AIDS, chronic renal failure, anemia, diameter of stone >2.5 cm and extremely long operation time [4]. Urosepsis is most commonly caused by Escherichiacoli [5].Two thirds of urosepsis caused Escherichia coli was extended spectrum beta-lactamase (ESBL) producers [6]. Although Escherichia coli induced urosepsis were predominant, little is known of the recent epidemiology of urosepsis associated Escherichia coli infection compared to others in Japan.…”