Time to recognition, aetiology, antibiotic sensitivity pattern and outcome of sepsis (sepsis 2 definition) in a tertiary care hospital in Sri Lanka

Abstract

Introduction: Patients with sepsis or severe sepsis usually present to the Emergency Department (ED). The overall mortality rate for patients admitted with severe sepsis is 35% - approximately five times higher than that of ST-elevation myocardial infarction. Prompt recognition and treatment are essential to improve survival. Our aim was to study the time to recognition, identify aetiology, and obtain antibiotic sensitivity patterns and outcome of patients presenting with suspected sepsis. Methodology: A prospective observational study including all patients suspected of having sepsis was carried out from July 1, 2016, to June 30, 2017, at the Emergency Department (ED) of the Provincial General Hospital Kurunegala, Sri Lanka. The study instrument was a data sheet comprising of the surviving sepsis guidelines (Sepsis 2) of the United Kingdom and demographics and background information from patient records. All the patients were followed up for one month. Results: One hundred and four patients (Age:61 ±17, 54.8% males) were studied. Blood culture results were available in 94 patients (90.4%) of which 19 (20%) were positive. The most common organisms identified were coagulase-negative Staphylococcus (CoNS) (42%) and Escherichia coli (42%). Door to blood culture time was 38.6 ± 26.7 minutes with 98% having blood cultures taken within 45 minutes of admission. Door to antibiotic time was 43.3 ±27.2 minutes. The most common primary foci of infection were pneumonia (34.6%) and cellulitis (28.8%). All CoNS were sensitive to teicoplanin and vancomycin, while all Escherichia coli isolates were sensitive to meropenem. The median (IQR) duration of hospital stay was 6 (3 to 9.1) days. The in-hospital mortality was 30 (28.9%) and 30-day mortality was 36 (34.6%). There was no statistical significance regarding mortality among blood culture positive and negative patients. Conclusion: The sepsis bundle had been activated within 45 minutes in most of our patients. The outcome of sepsis at our hospital is better than data published from other centres around the world.