The appropriate selection of empirical antibiotics based on the pattern of local antibiotic resistance antibiotics and sepsis reduce the mortality rate antibiotics and sepsis increase the rational use of antibiotics. We analyze the pattern of antibiotic use and the sensitivity patterns of antibiotics to support the rational use of antibiotics in patients with sepsis. A retrospective observational study was conducted in adult sepsis patient at one of Indonesian hospital during January-December Data were collected from the hospital medical record department.
Descriptive analysis was used in the processing and interpretation of data. A total of 76 patients were included as research subjects. Lung infection was the highest source of infection. The high use of antibiotic with a high level resistance requires a policy to support its rational use.
Local microbial pattern based on site infection and pattern of antibiotics sensitivity test can be used as supporting data to optimize appropriateness of empirical antibiotics therapy in sepsis patients. Sepsis is a systemic infection that can lead to complications and death. The therapeutic management of sepsis, including septic shock, requires a comprehensive and systematic approach that includes a diagnostic method, the initiation of empirical antibiotic use and administration of supportive therapy.
Empirical antibiotic therapy must also consider the site of infection, the common pathogen that caused sepsis and antibiotic sensitivity based on local patterns of antibiotic resistance, antibiotics and sepsis. In this study, we analyzed the pattern of antibiotic use in septic patients and the pattern of microbial resistance based on the results of various cultures antibiotics and sepsis microbial specimens from the sepsis patients.
The information gained will be critical as a reference for pathogen identification, antibiotics and sepsis, selection of empirical antibiotic therapy, and policies to control antibiotic resistance, especially in sepsis patients. A retrospective observational study was conducted in a hospital in Bandung, Indonesia during May to August Adult patients aged years, who were diagnosed with sepsis when admitted to the hospital from January 1 st to December 31 st, met the inclusion criteria for antibiotics and sepsis study.
The patients with incomplete information of antibiotic use were excluded. The data were collected from the medical records department of the hospital, including the patient identity, diagnosis, co-morbidities, source of infection, results of microbial culture, results of antimicrobial sensitivity testing, antibiotic use, length of stay and clinical outcome.
The level of antibiotic resistance was obtained from the results of the microbial cultures and antibiotic sensitivity testing that were conducted at the time of hospitalization from the subject population, antibiotics and sepsis. The data of antibiotic use were obtained from the medical records of the subject population. Culture and sensitivity test procedures were based on the principles of test that published by World Health Organization, antibiotics and sepsis.
Manual method was using to anticipate the error of automatic method with modified Kirby Bauer method. A total of patients, antibiotics and sepsis, males and 89 females, antibiotics and sepsis, were diagnosed with sepsis during the study period, and 76 patients met the criteria for the study.
The sepsis incidence rate was highest in the year age range with 15 patients, followed by the year age range with 14 patients. The incidence of sepsis was higher in females than males and the mortality rate from sepsis reached In contrast, in the year age group, the mortality rate in females There were 16 subject populations Lungs infection, renal failure, malignancy, diabetes mellitus and intraabdominal infection is the highest co-morbidities in the subject population.
In the lung infection antibiotics and sepsis, the major problem are hospital acquired pneumonia, community acquired pneumonia CAP and tuberculosis. The highest mortality showed in the subject population who got systemic lupus erythematous, hepatitis, meningitis, myocarditis, and human immunodeficiency virus infection. The characteristics of the subject population can be observed in Table 1. There were 6 sites of infection that developed into sepsis. A total of 5 patients had sepsis with multiple infections.
Microbial cultures of blood, sputum, a wound swab, pus, abscess, antibiotics and sepsis, feces, ascites fluid, antibiotics and sepsis, and urine from each patient were performed.
The results of the microbial cultures suggest that a patient could be infected by more than one microbe. There were 15 organisms detected by microbial culture from the various specimens. Klebsiella pneumoniae, Escherichia coli, Staphylococcus hominis, Candida albicans and Candida non-albicans were the organisms most frequently detected by microbial culture, antibiotics and sepsis. The other culture results were limited to show gram stain features and features of an acid fast stain, antibiotics and sepsis.
The results showed two organisms that were acid-fast bacilli, 11 organisms that were gram-negative cocci and 12 organisms that were gram-positive cocci.
The pattern of the organisms isolated from the various specimens can be observed in Table 2. We did not conduct antibiotic susceptibility tests on all antibiotics. The antibiotic resistance pattern is shown in Table 3. The level of antibiotic resistance based on susceptibility testing of the subject population. A total of 46 antibiotics were administered to the subject population with episodes of use.
The classes of antibiotics administered were penicillins, cephalosporins, carbapenems, quinolones, aminoglycosides, macrolides, glycopeptides, sulfonamides, polymyxins, antituberculosis agents, anthracyclines, antifungals, and others.
The pattern of antibiotic use in the subject population can be observed in Figure 1. Mortality rate in the sepsis patients affected by several factors, including early initiation and appropriateness of antimicrobial and non-antimicrobial therapy,[ 10 ] severity, age, gender, and co-morbidities. Controlling factors that may affect mortality is important to understand the relationship between age and mortality.
In this study, it is difficult to know this relationship, because several factors that affected in the mortality rate are uncontrolled.
Furthermore, we also found Although in this study it is difficult to know the relationship between age and mortality, antibiotics and sepsis, Carbajal-Guerrero et al. The influence of gender on the development of sepsis is still under debate. Studies show a higher incidence of sepsis in antibiotics and sepsis 13 ] than in women. Other studies have evaluated the influence of gender on survival in patients with sepsis[ antibiotics and sepsis14 ] with conflicting results, antibiotics and sepsis.
The difference between men and women in the risk of septicemia is due to differences in the immune response. Women have more estrogen antibiotics and sepsis than men, which influences greater activity of the immune system.
Early detection of sepsis is needed for early treatment to minimize mortality incidence. One of the marker that can be used to detect sepsis is procalcitonin, as shown by Azevedo et al. The most commonly found a source of infection for sepsis in this study was the lungs.
This finding concurs with previous studies that reported that lung infections were the highest source of infection for sepsis development. Common pathogens that can develop into sepsis based on the source of infection[ 2729303132333435 ], antibiotics and sepsis.
Based on the results of the bacterial cultures, K. CoNS are common organisms in nosocomial bacteremia due to the increases in medical device use including intravenous catheters, vascular grafts, prosthetic heart valves, and devices used in the treatment of joint disease.
CoNS microorganisms are most frequently isolated from blood cultures. The most commonly used antibiotics varied among institutions, but were typically composed of drugs that have levels of high resistance from some bacteria, such as Pseudomonas, E.
Making a microbiological diagnosis is mandatory. Negative result and contaminant result from the microbial cultures requires an evaluation to increase quality of microbiology diagnosis.
Internal evaluations are needed to maintain the quality of microbiology diagnosis. Forty-seven antibiotics were used. In our study, the most frequently used Based on the results of the microbial cultures, antibiotic susceptibility tests and patterns of antibiotic use, The high sensitivity of these antibiotics contributes to their use as an option in empirical antibiotic therapy, but the selection of which antibiotic to use antibiotics and sepsis consider the location of the infection source and factors specific to the patient, antibiotics and sepsis.
The pattern of antibiotic use with high resistance rates can be observed in Figure 2. The high frequency of use of antibiotics with high levels of resistance required special attention.
The high incidence of MDR can reduce the opportunities of patients to get the appropriate antimicrobial that can affect to increase the risk of antibiotics and sepsis. The emergence of microbial resistances were not by the availability of novel antimicrobial agents, which is marked by only four new classes of antibacterials have been discovered in the last 11 years.
In contrast with scheduled antibiotic changes, it has a predetermined and scheduled change in the predominant antimicrobial agent employed. The changes of antibiotic classes are often based on changing patterns of antimicrobial sensitivities and not simply time based. The others antibiotics heterogeneity strategy is antibiotic mixing, a strategy whereby all or most available antimicrobial classes are employed to minimize undue pressure for the emergence of resistance from having single or limited number of antibiotic classes available.
Broad spectrum antibiotics can be used in the critical ill patients to avoid inappropriateness of antibiotics which can be fatality. Modification of the initial antibiotics regimen should include decreasing the number and or spectrum antibiotics. Carbapenem is a broad spectrum antibiotic, which came in to use insince then, due to their good intrinsic bacterial activity and stability to most of the prevalent beta lactamase, they have been a drug of choice for extended spectrum beta lactamase-producing organism.
An evaluation of an antibiotic used and its antibiotics and sepsis should be monitored periodically to control the alteration of susceptibility. The most successful strategies to combat antibiotic resistance will be multidisciplinary, involving cooperation from the pharmacy, infection control, antibiotics and sepsis, nursing staff, treating physicians, microbiology laboratory personnel, and infectious disease consultants.
Such programs should also focus on promoting infection control practices and employing rational antibiotic utilization aimed at minimizing future emergence of resistance. Lung infection is the most common infection that is found in sepsis patient. The high use of antibiotics with high levels of resistance such as levofloxacin, ceftazidime, antibiotics and sepsis, ciprofloxacin, cefotaxime, ceftriaxone, and erythromycin requires a policy to control the use of antibiotics.
Microbial culture and resistance pattern were obtained from the local sepsis patients can be used as data to choose appropriatness of empirical antibiotic therapy for reducing mortality and morbidity in the sepsis antibiotics and sepsis. National Center for Biotechnology InformationU.
N Am J Med Sci. Ivan Surya Pradipta, Jl. Raya Bandung Sumedang Km. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.
This article has been cited by other articles in PMC. Antibiotic resistance, Bacteremia, Sepsis, Systemic infection, antibiotics and sepsis.
Introduction Sepsis is a systemic infection that can lead to complications and death. Materials and Methods A retrospective observational study was conducted in a hospital in Bandung, Indonesia during May to August Results Characteristics of the subject population A total of patients, males and 89 females, were diagnosed with sepsis during the study period, and 76 patients met the criteria for the study.
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