Chulalongkorn Medical Journal


Background : Sepsis is a clinical syndrome associated with a high mortality rate.Antimicrobial therapy is one of the milestones in the treatment of sepsis.Knowing the distribution of pathogens and local susceptibility ofantimicrobials would be beneficial for empirical antimicrobial usage.Objective : To determine the prevalence and characteristics of causative bacterialpathogens in culture-positive septic patients admitted to the EmergencyDepartment (ED) of King Chulalongkorn Memorial Hospital (KCMH).Study design : Retrospective descriptive study.Setting : The Emergency Department, KCMH, Bangkok, Thailand.Method : We reviewed medical records and computer databases of adult patientsadmitted to the ED from January to June 2013 with culture-positive sepsis.Result : This study included 300 culture-positive patients admitted to our ED forsepsis. Gram-negative bacteria were isolated in 251 patients (83.7%)while Gram-positive bacteria were isolated in 87 patients (29%). Amongthese patients, 204 (68.0%) had only Gram-negative infections; 43 (14.3%)had only Gram-positive infections, while 44 (14.7%) had mixed Gram-positive and Gram-negative infections. Escherichia coli, Klebsiellapneumoniae, and Pseudomonas aeruginosa were the three most commonbacteria isolated from 132 (44%), 57 (19%), and 34 (11.3%) patients,respectively. Third generation cephalosporin resistant E. coli, third generationcephalosporin resistant K. pneumoniae and Acinetobacter baumanniiisolates were more common pathogens in healthcare-associated thancommunity-acquired cases (26.5% vs 12.3%, 8.6% vs 2.2%, and 10.5% vs3.6%; respectively; all p <0.05).Conclusion : Gram-negative bacteria were the predominant causative pathogens ofsepsis in patients at the ED.E. coli, K. pneumoniae, and P. aeruginosawere the three most common bacterial pathogens. Third generationcephalosporin resistant microorganisms and A. baumanii were found morein healthcare-associated than community-acquired sepsis.


Faculty of Medicine, Chulalongkorn University

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