Analysis of Blood Cultures of Patients Presenting to the Emergency Department in a Tertiary Healthcare Hospital in Mumbai

Deepak Kishor Sharma, Sandeep B Gore
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Abstract

Aim and objectives: Analysis of blood cultures taken from patients attending emergency departments is an important exercise in determining the common pathogens prevalent in the region. The distribution of these infective pathogens keeps changing over time, and the rise in antimicrobial-resistant pathogens makes it difficult to routinely conduct effective empirical broad-spectrum antimicrobial therapy. This study aimed to analyse the results of blood cultures obtained from patients presenting to the Emergency Department of a Tertiary Healthcare Hospital in Mumbai and provide updated and detailed information on the distribution of causative pathogens in adult sepsis and study their antibiotic-susceptibility pattern. Materials and methods: A hospital-based prospective cross-sectional study of 121 positive blood culture reports was conducted at the Department of Emergency Medicine, Fortis Hospital Mulund, Mumbai, which included all adult (age > 18 yrs) suspected sepsis patients arriving to the Emergency Department whose blood cultures were sent from the Emergency Department from January 2021 to December 2021. Results: The study showed that mean age of the study cases was 59.3 years with 59.5% cases that belonged to the elderly age group with a male predominance (56.2% males–43.8% females). Overall, Gram-negative isolates were seen in 95% cases, while Gram-positive isolates were seen in only 1.7% cases. The most common organism isolated from cases with sepsis was Escherichia coli (45.5%) followed by Klebsiella (13.2%), Salmonella (10.7%), Stenotrophomonas (7.4%) and Pseudomonas (5%). Among Gram-positive organisms, Staphylococcus aureus was the most common organism isolated (1.7%). Escherichia coli isolates showed poor sensitivity towards fluoroquinolones and cephalosporins while good sensitivity towards aminoglycosides, carbapenems and combination drugs like Cefoperazone and Sulbactam and Piperacillin and Tazobactam. These findings suggest that Gram-negative organisms are the most common isolates observed in this study, with E. coli being the predominant pathogen followed by Klebsiella. High-level antimicrobial resistance was observed in sepsis cases for commonly used antimicrobials like fluoroquinolones and cephalosporins.
孟买一家三级医疗保健医院急诊科患者的血培养分析
目的和目标:对急诊科就诊患者的血液培养物进行分析是确定该地区常见病原体的一项重要工作。随着时间的推移,这些感染性病原体的分布不断发生变化,耐抗菌素病原体的增加使得常规有效的经验性广谱抗菌疗法难以实施。本研究旨在分析孟买一家三级医疗保健医院急诊科患者的血液培养结果,提供成人败血症致病病原体分布的最新详细信息,并研究其抗生素敏感性模式。材料和方法:孟买 Fortis Mulund 医院急诊医学科对 121 份血培养阳性报告进行了医院前瞻性横断面研究,研究对象包括 2021 年 1 月至 2021 年 12 月期间急诊科送检的所有成人(年龄大于 18 岁)疑似败血症患者。研究结果研究显示,研究病例的平均年龄为 59.3 岁,59.5% 的病例属于老年组,男性占多数(56.2% 为男性,43.8% 为女性)。总体而言,95%的病例分离到革兰氏阴性菌,而革兰氏阳性菌仅占 1.7%。败血症病例中最常见的分离菌是大肠埃希菌(45.5%),其次是克雷伯菌(13.2%)、沙门氏菌(10.7%)、血吸虫(7.4%)和假单胞菌(5%)。在革兰氏阳性菌中,金黄色葡萄球菌是最常见的分离菌(1.7%)。分离出的大肠埃希菌对氟喹诺酮类和头孢菌素的敏感性较差,而对氨基糖苷类、碳青霉烯类和头孢哌酮与舒巴坦、哌拉西林与他唑巴坦等复方药物的敏感性较高。这些发现表明,革兰氏阴性菌是本研究中最常见的分离菌,其中大肠杆菌是最主要的病原体,其次是克雷伯氏菌。在败血症病例中,对氟喹诺酮类和头孢菌素类等常用抗菌药物产生了高度耐药性。
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