Organisms of Interest in the Case of Admission for Sepsis at Portiuncula University Hospital, Co Galway, Ireland.
Sepsis is a dysregulated systemic immune response that is caused by the presence of pathogenic microorganisms and or their toxins in the blood stream. The timing of clinical intervention is essential to the survival of the septic patient. Early identification of sepsis with the appropriate treatment significantly increases the chances that the patient will survive. An antecedent infection usually serves as a source of sepsis and common sites of infection are the urinary-tract, respiratory tract and abdomen. Elderly patients are more susceptible to sepsis and have less physiologic reserve to tolerate the insult from infections and are likely to have atypical presentations
This study analysed data of all patients admitted from the Emergency Department (ED) for sepsis and reviewed specifically the prevalence of pathogens that are associated with sepsis and increased rate of ICU admissions of patients.
The retrospective study was carried out between the periods of September-2017 to February-2018 on 149 patients that were admitted due to Sepsis. Charts were analysed and data collected recording them on a excel spreadsheet. The mean age was 69, 71 males and 78 females. Blood Cultures isolated E.coli: 31(20.8%,CI31:149), Staph Aureus: 28(19.17%,CI28:149), ), Strep Pneumoniae: 26(17.80%,CI26:149), Pseudomonas Aeruginosa :10 (6.84%, CI10:149), B-haemolytic group B strep:7(4.79%,CI7:149), Mixed:16 (10.95%,CI 16:149), Klebsiella: 5(3.35%,CI5:149), Enterococcus faecium: 7(4.69%,CI7:149), Gram + Cocci VRE: 6(4.10%,CI6:149), others 26 included 1 CMV 1 Herpes simplex and 2 Yeast cultures. There were 75 ICU admissions from the ED and their blood cultures isolated: E.coli:21(28%, CI 21:75), Staph Aureus: 19(25.3%,CI19:75), Strep Pneumoniae:17(22.6%,CI17:75) Mixed:10(13.3%,CI10:75), Pseudomonas Aeruginosa:5(6%,CI5:75), B-haemolytic group B:3(4%,CI3:75).The focus of infections was identified as respiratory in 54 cases, urinary 52, abdominal 4, 19 other sources and 20 no sources identified. The most prescribed antibiotic was Tazocin 57, Augmentin 42, Gentamycin 17, Clindamycin 4 and others 21.
There are several factors that influence ED presentations with sepsis. Many elderly patients frequently attend ED. Many live in nursing homes and have been admitted to hospitals before. They have co-morbidities, have a varied response to infection and may have been prescribed antibiotics by their doctor. Bacteria (gram-positive and gram-negative) are identified as the causative organism in approximately 90% of cases. The frequency of gram-positive sepsis mainly caused by Staphylococcus aureus, coagulase-negative staphylococci, enterococci, and streptococci has surpassed that of gram-negative sepsis mainly caused by Enterobacteriaceae, especially Escherichia coli and Klebsiella pneumoniae, and by Pseudomonas aeruginosa. E coli are the most prevalent pathogen causing sepsis. 75% of cases of sepsis arose as a result of community-acquired infection. The focus of infection in this study revealed that respiratory tract infections accounted for almost equal amounts of infection as for urinary infections. A definite source of infection was not found in some cases. Resistance patterns of organisms were noted with methicillin-resistant S aureus (MRSA), vancomycin-resistant enterococci (VREs) isolated and thus control of nosocomial antimicrobial-resistant bacteria must continue to be a strategic priority. A significant number of E coli isolates that are now resistant to Amoxicillin/Clavulanic acid (Augmentin) and Extended-spectrum beta-lactamase-producing Enterobacteriaceae maybe the reason for increased use of Piperacilin-Tazobactam (Tazocin).
