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

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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=0.006 by unpaired t-test) and chronic kidney disease (P=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.

Original languageEnglish
Pages (from-to)228-235
Number of pages8
JournalPathogens and Global Health
Volume109
Issue number5
DOIs
Publication statusPublished - 01-07-2015

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Tertiary Healthcare
Tertiary Care Centers
Sepsis
Cohort Studies
Carbapenems
APACHE
Prospective Studies
Intensive Care Units
Cross Infection
Chronic Renal Insufficiency
Mortality
Catheter-Related Infections
Acinetobacter baumannii
Equipment and Supplies
Klebsiella pneumoniae
Multiple Drug Resistance
beta-Lactamases
Methicillin-Resistant Staphylococcus aureus
Drug Resistance
Pseudomonas aeruginosa

All Science Journal Classification (ASJC) codes

  • Parasitology
  • Microbiology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

@article{7de990c304ba471f981718cb4f531882,
title = "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=0.006 by unpaired t-test) and chronic kidney disease (P=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.",
author = "Kavitha Saravu and Madhura Prasad and Eshwara, {Vandana Kalwaje} and Chiranjay Mukhopadhyay",
year = "2015",
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day = "1",
doi = "10.1179/2047773215Y.0000000026",
language = "English",
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pages = "228--235",
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T1 - Clinico-microbiological profile and outcomes of nosocomial sepsis in an Indian tertiary care hospital - A prospective cohort study

AU - Saravu, Kavitha

AU - Prasad, Madhura

AU - Eshwara, Vandana Kalwaje

AU - Mukhopadhyay, Chiranjay

PY - 2015/7/1

Y1 - 2015/7/1

N2 - 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=0.006 by unpaired t-test) and chronic kidney disease (P=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.

AB - 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=0.006 by unpaired t-test) and chronic kidney disease (P=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.

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U2 - 10.1179/2047773215Y.0000000026

DO - 10.1179/2047773215Y.0000000026

M3 - Article

VL - 109

SP - 228

EP - 235

JO - Pathogens and Global Health

JF - Pathogens and Global Health

SN - 2047-7724

IS - 5

ER -