Clinico-microbiological profile of sepsis with carbapenem-resistant Gram-negative isolates among patients presenting to a large tertiary care hospital in South Kerala
Aneesh Chacko1, Aneeta Mary Jacob2, Mathew Pulicken3, Philip Mathew4, Jijo Paul5
1 Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
2 Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
3 Department of Critical Care Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
4 Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala, India
5 Department of Anaesthesiology, Sanjeevani Multispeciality Hospital, Alappuzha, Kerala, India
Dr. Aneeta Mary Jacob
Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala
Source of Support: None, Conflict of Interest: None
BACKGROUND AND OBJECTIVES: Increasing antibiotic resistance, particularly among carbapenems, has made the management of sepsis very challenging. Early and aggressive use of appropriate antimicrobials is essential in improving the clinical outcome of these patients. The aim of this study was to find the various risk factors leading to sepsis with carbapenem-resistant organisms (CRO) and also to analyse the various clinical outcomes among sepsis due to CRO.
MATERIALS AND METHODS: Blood cultures were processed from patients who presented with signs and symptoms of sepsis. Analysis for predisposing factors and clinical outcome was done for those patients who grew CRO in both blood cultures. For calculation of significance, the same factors were also studied in an equal number of patients who presented with sepsis due to carbapenem-sensitive organisms.
RESULTS: Blood cultures were received from a total of 3885 patients in one year, of which 7.6% grew Gram-negative bacilli. Resistance to carbapenems was seen in 17.9% of isolates. The significant risk factors for sepsis with CRO in the present study were chronic liver disease, increased duration of hospital stay and exposure to antibiotics. Carbapenem-resistant sepsis was associated with increased mortality. This may be related to the delay in initiating definitive therapy after the onset of sepsis.
INTERPRETATION AND CONCLUSION: Colistin is the drug of choice for carbapenem-resistant sepsis. Being a reserve drug, we recommend Colistin to be restrictively used as an empiric therapy only in those patients who developed sepsis after hospital stay, who had prolonged antibiotic exposure as well as in patients with chronic liver disease.