Prevalence of Antimicrobial Resistant Pathogens in Severe Sepsis and Septic Shock Patients

Emergence of antimicrobial resistance is turning to be a life threatening problem in the treatment of patients with severe sepsis and septic shock. Many organisms display a multidrug resistant (MDR) pattern, which limits the treatment options. Aim: The purpose of this study was to assess the prevalence of pathogens including the resistant types causing severe sepsis and septic shock as well as their antimicrobial resistance patterns. Methods: This was a prospective, observational study conducted at emergency department of a tertiary care hospital. A total of 293 bacterial isolates obtained during April 2015-16 inclusive, from severe sepsis and septic shock patients underwent susceptibility testing. Results: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Candida albicans and Candida non-albicans were the most common organisms.With respect to the specimen source, majority of the isolates (38.6%) were obtained from urine specimens followed by blood (27%), skin/soft tissue specimen (16.4%) and respiratory specimen (15%). Escherichia coli showed good susceptibility to amikacin, meropenem and piperacillin-tazobactam. Klebsiella pneumoniae showed high rates of resistance to all the tested antimicrobials except colistin. The MDR phenotype occurred in 24.6% Escherichia coli, 30.4% Pseudomonas aeruginosa, 56.4% Klebsiella pneumoniae and 87.5% Acinetobacter baumannii. No resistance was seen among fungal isolates. Conclusion: Our results highlight the high prevalence of gram negative organisms among severe sepsis and septic shock patients in south India. Strict implementation of sepsis guidelines, right antibiotic selection and dosage will help in preventing the development of resistance.