Predictors of thirty-day mortality among patients with blood stream infection with WHO priority pathogens: single centre exploratory study from a referral teaching hospital in central India

Akshit Budhiraja; Tadepalli Karuna; Farhan Khan; Shweta Kumar; Namitha Shaji; Ehsaas Bajaj; Shashank Purwar; Abhijit Pakhare; Rajnish Joshi; Saurabh Saigal; Sagar Khadanga

doi:10.18502/ijm.v16i3.15748

Akshit Budhiraja Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
Tadepalli Karuna Department of Microbiology, AIIMS Bhopal, Saket Nagar, Bhopal, India
Farhan Khan Department of Community and Family Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
Shweta Kumar Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
Namitha Shaji Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
Ehsaas Bajaj Department of General Medicine, Undergraduate Student, AIIMS Bhopal, Saket Nagar, Bhopal, India
Shashank Purwar Department of Microbiology, AIIMS Bhopal, Saket Nagar, Bhopal, India
Abhijit Pakhare Department of Community and Family Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
Rajnish Joshi Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India
Saurabh Saigal Department of Critical Care, AIIMS Bhopal, Saket Nagar, Bhopal, India
Sagar Khadanga Department of General Medicine, AIIMS Bhopal, Saket Nagar, Bhopal, India

DOI: https://doi.org/10.18502/ijm.v16i3.15748

Keywords: Antimicrobial stewardship; Bacteremia; Drug resistance; Mortality; Sepsis

Abstract

Background and Objectives: Bloodstream infection (BSI) is defined by the presence of viable microorganisms in the blood- stream. BSI is one of the major causes of sepsis and subsequent adverse clinical outcomes all across the globe. The present study was undertaken to identify clinico-epidemio-microbiological variables associated with 30-day mortality in patients having BSI with WHO priority pathogens.

Materials and Methods: The study was conducted at a public sector tertiary care institute in central India from April 2019 to March 2021. Blood samples collected from patients with clinical suspicion of sepsis, were processed by automated bacterial culture system and interpreted as per CLSI guidelines. Calculated sample size was 150. Data was analyzed by R software. Results: Respiratory tract infection was the most common source (43.3%) of BSI, followed by the gastrointestinal (20%) and urinary tract (18.7%). Among the patients, 33% required invasive mechanical ventilation, and 31% required inotropes. Di- abetes mellitus (DM) was the most common co-morbidity (34%). The incidence of multi-drug resistant organisms (MDRO) was 59.3%. Escherichia coli was the most commonly (24%) isolated organism, followed by Klebsiella pneumoniae (17.3%) and Acinetobacter baumannii (16%).

Conclusion: Higher age, higher qSOFA score / SIRS score / mean SOFA score at presentation had higher mortality. Use of mechanical ventilation and inotropes during treatment and isolation of critical category organisms of WPP and multi drug resistant organisms were independent 30-day mortality predictors.