Sepsis in Adults: Microbiological Agents and Antimicrobial Prescribing Patterns at BPKIHS

Background As per Surviving Sepsis Campaign, early and empirical antibiotic treatment should be started in a patient suspected of severe bacterial infection. Many patients with sepsis remain in the emergency ward (EW) for several hours, the role of emergency physician in selecting appropriate antibiotics may be critical in lowering the mortality rate in patients with sepsis.15, 22, 23 The goal of this study was to determine whether first line antibiotics selected by emergency physicians effectively covered disease causing organisms in patients presenting to EW with septic shock or severe sepsis. Materials and Methods A cross sectional descriptive study was conducted for a period of one year from july 2013 to july 2014. All patients 16 years of age in EW with features of sepsis were included in the study. Samples were collected as per the standard protocol. The calculated sample size was 101. Data were entered in MS-EXCEL, converted to SPSS and analysed for different variables. Result 421 cases were included, mean age was 36 16.9 years with malefemale = 12. Common sources of infection were urinary tract 45.84 %, lungs and pleura 17.10 %. Fever was most common (76.2 %) complain in EW followed by cough (15.7 %) and pain abdomen (12.4 %). Overall culture positivity was 33.73 %. Common isolated organisms were E. coli 35.91 % and Staph. aureus 33.1 %. Frequently prescribed antibiotics in EW were Ceftriaxone 70.5 %, Metronidazole 42.7 %, Piperacillin-Tazobactab 30.4 %, Ciprofloxacin 21.4 %. The susceptibility of ceftriaxone was maximum for against staph.44 % and 85 % for most of the organisms. The maximum susceptibility of ciprofloxacin was 50 %. and that of vancomycin, tigecycline and linezolid is preserved to 100 % in this study. Conclusion There is high prevalence of multi drug resistant organism which leads to inappropriate empirical antibiotic prescription and associated increased mortality. So local susceptibility pattern should be reviewed periodically and accordingly protocol for empiric antibiotic prescription should be made in the EW for better outcome of patients of sepsis and septic shock.