The relationship between bacterial types and antibiotic resistance with the clinical outcomes of sepsis patients in Pediatric Intensive Care Unit at Sanglah Hospital Denpasar, Bali-Indonesia

Abstract

Background: Sepsis in children could significantly increase the morbidity and mortality rates particularly in the Pediatric Intensive Care Unit (PICU). Moreover, the prevalence of antibiotic resistance is continuously increasing around the world mainly caused by uncontrolled used of antibiotic. Henceforth, this study aimed to determine the relationship between bacterial type and the resistance with clinical outcome of sepsis patients in PICU.Methods: An observational analytic retrospective cohort study using medical record data from January 2015-April 2017 was conducted. All subjects were sepsis patients with positive blood cultures treated at PICU Sanglah Hospital. Factors related to mortality and relative risk (RR) were analyzed using Chi-Square Test with a significance value of p <0.05 with 95% confidence interval (CI).Results: 75 subjects met the inclusion criteria, but only 63 subjects with complete data were enrolled. The gram-negative and MDR bacteria types were detected in 31 (49%) subjects and 33 (52.4%) subjects respectively. The number of deaths was 29 (46%). The most common types of gram-negative bacteria were Pseudomonas aeruginosa (16%) followed by gram-positive Staphylococcus hominis (25%). The most common multi-drug resistant (MDR) bacteria were Staphylococcus hominis. The presence of MDR bacteria significantly increase the mortality (p = 0.015, RR 2.02, 95% CI: 1.096-3.725), whereas gram-negative had no significant mortality impact (p = 0.891: RR 0.96; 95% CI: 0.564- 1.645). Compared to non-MDR bacteria, most MDR related mortality occurred during the first 10 days.Conclusion: MDR bacteria significantly increased the mortality rates in pediatric patient treated in PICU compared to non-MDR ones.Â

Epidemiology and Characteristics of Elizabethkingia spp. Infections in Southeast Asia

“…In Jakarta, a group of researchers from the Eijkman Institute reported the presence of E. meningoseptica in one non-dengue febrile patient [ 118 ]. A retrospective cohort study conducted at the Pediatric Intensive Care Unit at Sanglah Hospital in Denpasar, Bali, Indonesia, from January 2015 to April 2017 led to the isolation of E. meningoseptica from one of their patients’ blood samples diagnosed with septicemia [ 25 ]. In a cross-sectional study conducted between April and August of 2015 in the neonatology ward of Haji Adam Malik Hospital in Medan, North Sumatra, 3 out of 43 neonates were found positive for E. meningoseptica from their blood samples, although the method of identification was not stated [ 96 ].…”

“…From the 283 cases that were reviewed, 209 of the patients were diagnosed with meningitis [ 2 ]. Infections by this pathogen have been reported in many parts of the world, including in Southeast Asian countries such as Malaysia [ 2 ], Singapore [ 23 ], Thailand [ 24 ], Indonesia [ 25 ], and Cambodia [ 26 ]. However, until now, there have been no published reports from other Southeast Asian countries such as the Philippines, Brunei, Myanmar, Laos, and Timor-Leste.…”

Characteristic of Bacterias And Antibiotic Sensitivity of Blood Culture in Sepsis

“…Another survey conducted in PICU of Sanglah Hospital Bali also confirmed the incidence of sepsis in neonates and infants with the primary source of infection the respiratory tract and community-acquired infection. 9 However, a contradictive result was exhibited by a study conducted in PICU of Mohammad Hoesin Hospital Palembang, stating that hospital infections were higher than community infections (95.8%). 10 Patients with sepsis in 2017 were predominantly male (68.4%), while in 2018 patients with sepsis mostly female(55.6%).…”

Antibiotic Use and Resistance at Intensive Care Unit of a Regional Public Hospital in Bali: A 3-Year Ecological Study

“…Penelitian yang dilakukan di Bali dan Jawa Barat menganalisis tentang tingkat penggunaan antibiotik dan hubungan antara resistensi bakteri terhadap antibiotik dan clinical outcome. 11,12 Penelitian yang dilakukan di Bandung menyatakan bahwa tiga golongan antibiotik yang paling banyak digunakan di ICU adalah antibiotik golongan beta laktam (36%), fluorokuinolon (22%), dan antibiotik kombinasi beta laktam (17%). 11 Penelitian yang dilakukan di Bali menyatakan bahwa bakteri dengan multi drug resistant (MDR) secara siginifikan dapat meningkatkan angka kejadian mortalitas (p<0,05).…”

“…11 Penelitian yang dilakukan di Bali menyatakan bahwa bakteri dengan multi drug resistant (MDR) secara siginifikan dapat meningkatkan angka kejadian mortalitas (p<0,05). 12 Dari latar belakang tersebut, perlu dilakukan studi tentang hubungan tingkat penggunaan antibiotik yang dinyatakan dalam defined daily doses (DDD) dengan resistensi bakteri terhadap antibiotik di ICU yang dapat menjadi dasar evidence dalam merencanakan program guna mengontrol tingkat penggunaan antibiotik yang berdampak terhadap resistensi bakteri di ICU.…”