Bacterial diversity in sepsis patients under ICU care and their antibiotic resistance pattern in Diabetic patients in comparison to non-Diabetic patients with sepsis

Abstract

OBJECTIVE: Sepsis and septic shock are the leading cause of morbidity and mortality in both diabetic and non-diabetic patients with a wide diversity of bacteria prevalent in the community. Local data about antimicrobial resistance in both diabetic and non-diabetic patients should be available for proper initiation of empirical therapy. Our aim is to evaluate the spectrum of pathogens causing sepsis and septic shock and their profiles of antimicrobial resistance on a series of diabetic and non-diabetic patients. PATIENTS AND METHODS: A prospective observational study with 495 participants was conducted targeting the diabetic and non-diabetic patients admitted with sepsis or septic shock in intensive care unit (ICU). Antibiotic sensitivity test was done on each of the isolates and the results of the antibiogram were compared between diabetic and non-diabetic patients. The statistical analysis was done by Chi-Square test, Fisher’s exact test using statistical product and service solutions known as statistical package for the social sciences (SPSS), 17.0 version (Chicago, IL, USA). RESULTS: The most common isolated organism was Klebsiella followed by Escherichia coli, Staphylococcus, Acinetobacter and Enterococcus in both diabetic and non-diabetic patients. Highest sensitivity was seen for tigecycline and colistin whereas highest resistance was seen for cephalosporin, fluoroquinolones and carbapenems in both diabetic and non-diabetic patients. Statistically significant results were seen for sensitivity for Trimethoprim-sulfamethoxazole for Acinetobacter and Escherichia coli. Statistically significant results for carbapenem, beta Lactam + beta Lactamase Inhibitor, cefepime were observed for Klebsiella and for teicoplanin and vancomycin was observed for Enterococcus. CONCLUSIONS: This study helps to understand the diversity of bacteria prevalent in community and formulate a better empirical antibiotic usage policy with proper implementation of antibiotic stewardship in a better way. Empirical antibiotic therapy should be prescribed only after performing antimicrobial susceptibility testing in order to obtain a better outcome.

Keywords

• sepsis
• bacterial diversity
• resistance pattern
• diabetes
• gram negative bacteria
• gram positive bacteria