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 of antimicrobials would be beneficial for empirical antimicrobial usage. Objective : To determine the prevalence and characteristics of causative bacterial pathogens in culture-positive septic patients admitted to the Emergency Department (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 patients admitted to the ED from January to June 2013 with culture-positive sepsis. Result : This study included 300 culture-positive patients admitted to our ED for sepsis. Gram-negative bacteria were isolated in 251 patients (83.7%) while Gram-positive bacteria were isolated in 87 patients (29%). Among these 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, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the three most common bacteria isolated from 132 (44%), 57 (19%), and 34 (11.3%) patients, respectively. Third generation cephalosporin resistant E. coli, third generation cephalosporin resistant K. pneumoniae and Acinetobacter baumannii isolates were more common pathogens in healthcare-associated than community-acquired cases (26.5% vs 12.3%, 8.6% vs 2.2%, and 10.5% vs 3.6%; respectively; all p <0.05). Conclusion : Gram-negative bacteria were the predominant causative pathogens of sepsis in patients at the ED.E. coli, K. pneumoniae, and P. aeruginosa were the three most common bacterial pathogens. Third generation cephalosporin resistant microorganisms and A. baumanii were found more in healthcare-associated than community-acquired sepsis.



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