The antimicrobial susceptibility patterns in patients with blood culture positive sepsis at the accident and emergency department Kenyatta National Hospital

Abstract

Background Sepsis and septic shock are a major cause of morbidity and mortality globally. The case fatality rate in the developing countries is twice that in the developed world. Being a treatable cause of mortality, a lot of research has gone into determining the causes of death in patients who present with sepsis. Key among them is the fact that most patients especially in the developing countries present late having gone into septic shock and end organ damage. In addition, most centers in the developing world do not have antimicrobial sensitivity patterns to inform appropriate empiric therapy early in the disease. Study objective To determine the antimicrobial susceptibility patterns among patients with blood culture positive sepsis at the accident and emergency department Kenyatta National Hospital, Nairobi-Kenya. Methodology This was a descriptive cross sectional study. The study participants were adults attending the accident and emergency department of Kenyatta National Hospital. A total of 288 patients with SIRS were screened and an informed consent obtained on 232 patients who met the study criteria. A targeted history and examination to identify the foci of infection was performed then two blood culture samples were obtained per patient using a standard, aseptic process. The samples were sent to the University of Nairobi microbiology laboratory for incubation and susceptibility testing (using disc diffusion method) within three hours of collection. Results We recruited 232 patients out of which 120 (51.7%) were female and 15% were HIV positive. Twenty four percent of our patients were referred from another facility. A third (28%) had used antibiotics prior to recruitment. Infections of the respiratory system were the most frequent (26%) followed by soft tissue infections (20%). xi Out of the 232 blood samples drawn for culture, a total of 15 (6.5%) grew pathologically significant bacteria. The most common organisms were gram positive bacteria with Coagulase negative Staphylococcus aureus being the most common at 40%. As far as the susceptibility to antibiotics was concerned, the majority of the bacteria were susceptible to the most commonly used antibiotics, with the least resistance against carbapenems and third generation cephalosporins..The highest resistance was against the penicillins and the macrolides. Conclusions Majority of our patients were from the community and the most common causative organisms were gram positive bacteria with high susceptibility to the commonly used antibiotics. Coagulase negative Staphylococcus aureus was the most commonly isolated organism. Most organisms were sensitive to levofloxacin, third generation cephalosporins and carbapenems.