Arzneimittelforschung 2012; 62(03): 117-122
DOI: 10.1055/s-0031-1298005
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Antimicrobial Therapy and Outcome of Septicemia Patients Admitted to a University Hospital in Delhi

M. S. Alam
1   Department of Pharmacology, Faculty of Pharmacy, Hamdard University, New Delhi, India
,
P. K. Pillai
2   Department of Microbiology, Majeedia Hospital, Hamdard University, New Delhi, India
,
P. Kapur
3   Hamdard Institute of Medical Sciences & Research and Hakeem Abdul Hameed Centenary Hospital, Hamdard University, New Delhi, India
,
K. K. Pillai
1   Department of Pharmacology, Faculty of Pharmacy, Hamdard University, New Delhi, India
› Author Affiliations
Further Information

Publication History

received 04 November 2011

accepted 07 November 2011

Publication Date:
19 January 2012 (online)

Abstract

Septicemia is a common clinical condition encountered in most of the hospitals in this region of the world. However, limited information is available in the Indian literature on antimicrobial usage in patients with suspected or proven cases of septicemia. The aim of the present study is on the one hand to describe the clinical characteristics of septicemia, the causative pathogens, the current pattern of antimicrobial use, the clinical outcome, the acquisition cost of commonly used antimicrobial regimens and on the other hand to monitor adverse drug reactions (ADRs) during therapy of septicemia patients admitted to a University Hospital in Delhi. We prospectively reviewed the antimicrobial therapy in 34 clinically diagnosed septicemia cases admitted to a University Hospital from July 2009 to December 2009. All study patients presented various clinical signs and symptoms, fever, diarrhoea and vomiting were most commonly reported. Microorganisms could be identified in 13 (38.2%) of the patients. Escherichia coli (41.2%) constituted the most prevalent bacterial pathogen. Among culture positive patients, 15.4% received ceftriaxone as the most common empirical antimicrobial therapy; among culture negative patients, 19% received cefotaxime plus amikacin as the most common empirical antimicrobial therapy. The average acquisition cost of the 1st line antimicrobial regimen was higher in culture positive than in culture negative patients, but it was reversed for the 2nd line therapy. Overall, 67.6% patients were discharged after recovery, 23.5% were transferred out and 8.8% died during the course of therapy. 9 (26.5%) patients experienced ADRs during the antimicrobial therapy. These findings may have an important implication for developing comprehensive, evidence-based guidelines for the practical treatment of septicemia, adherence to which may lead to a more rational antimicrobial therapy, to cost reduction and to an improved level of care of patients with septicemia.

 
  • References

  • 1 Kang-Birken SL, Dipiro JT. Sepsis and septic shock. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wels BG, Posey LM. (eds.). Pharmacotherapy, a pathophysiologic approach. 5th edition. New York: International Publication; 2002: 2029-2041
  • 2 Slade E, Tamber PS, Vincent JL. The surviving sepsis campaign: raising awareness to reduce mortality. Crit Care 2003; 7: 1-2
  • 3 Kochanek KD, Smith BL. National Vital Statistics Reports. Deaths: Preliminary Data for 2002. Atlanta: Centers for Disease Control and Prevention; 2004. 52. 13
  • 4 IndiaNewsPost – Over 900 births and 300 deaths in Delhi every day.htm.
  • 5 Cohen J. The immuno pathogenesis of sepsis. Nature 2002; 420: 885-891
  • 6 Dellinger RP, Levy MM, Carlet JM et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock. 2008; Inten Care Med 2008; 34: 17-60
  • 7 Blomberg B, Jureen R, Manji KP et al. High rate of fatal cases of pediatric septicemia caused by gram-negative bacteria with extended-spectrum betalactamases in Dar es Salaam, Tanzania. J Clin Microbiol 2005; 43: 745-749
  • 8 Garnacho-Monlevo J, Ortiz-Leyba C, Herrera-Melevo I et al. Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to ICU with sepsis: a matched cohort study. J Antimicrob Chemother 2008; 61: 436-441
  • 9 Ibrahim EH, Sherman G, Ward S et al. The influence of inadequate antimicrobial treatment of blood stream infections on patient outcomes in the ICU setting. Chest 2000; 118: 146-155
  • 10 Fraser A, Paul M, Aimanasareh N et al. Benefits of appropriate empiric antibiotic treatment: thirty day mortality and duration of hospital stay. Am J Med 2006; 119: 970-976
  • 11 Munford SM. Severe sepsis and septic shock. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. (eds.). Harrison’s Principles of Internal Medicine. 16th edition, volume 2. New York: McGraw Hill; 2005: 1606-1612
  • 12 International drug monitoring. The role of national centers. World Health Organization Tech Rept Ser 1972; 498: 1-25
  • 13 Gray J, Gossain S, Morris K. Three-year survey for bacteremia and fungemia in a pediatric intensive care unit. Pediatr Infect Dis J 2001; 20: 416-421
  • 14 Luzzaro F, Vigano EF, Fossati D et al. Prevalence and drug susceptibility of pathogens causing bloodstream infections in northern Italy: a two year study in 16 hospitals. Eur J Clin Microbiol Infect Dis 2002; 21: 849-855
  • 15 Mehta M, Dutta P, Gupta V. Antimicrobial susceptibility pattern of blood isolates from a teaching hospital in north India. Jap J Infect Dis 2005; 58: 174-176
  • 16 Mamishi S, Pourakbari B, Ashtiani MH et al. Frequency of isolation and antimicrobial susceptibility of bacteria isolated from bloodstream infections at Children’s Medical Center, Tehran, Iran, 1996–2000. Int J Antimicrob Agents 2005; 26: 373-379
  • 17 Bhagwanjee S, Scribante J, Perrie H et al. PISA: the prevalence of infection in intensive care units in South Africa. Crit Care 2007; 11: 66
  • 18 Degoricija V, Sharma M, Legas A et al. Survival analysis of 314 episodes of sepsis in medical intensive care unit in University Hospital: impact of intensive care unit performance and antimicrobial therapy. Croat Med J 2006; 47: 385-397
  • 19 Munson EL, Diekema DJ, Beekmann SE et al. Detection and treatment of bloodstream infection: laboratory reporting and antimicrobial management. J Clin Microbiol 2003; 41: 495-497
  • 20 Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med 1999; 340: 207-214