Bacteremia and septicemia in Qatar

Abstract

Objectives: The aims of the study are to define the pattern of bacteremia and septicemia in Hamad Medical Corporation in relation to the susceptibility of the implicated microbes to various antimicrobial agents. Methods: During a period of 12 months of study, blood cultures were performed on 9074 patients in Hamad Medical Corporation, Qatar, with clinical signs of infection. Among these, 789 (9%) episodes of septicemia were diagnosed, which corresponds to 20/1000 hospital admissions. Results: About 59% of the episodes were due to Gram positive organisms, the most common of which were coagulase negative staphylococci (31%), Staphylococcus aureus (7%) and Candida spp (6%), and other Gram positive organisms. Gram negative organisms implicated in 40% of episodes were mainly Salmonella spp (8%), Escherichia coli (7%), Klebsiella spp (5%) and other Gram negative organisms. The antibiotic resistance pattern of the organisms showed that S.aureus had the highest incidence of drug resistance. The case fatality rate among 66 episodes of septicemia was 24%, which increased with age, but was not influenced by sex. Polymicrobial septicemia carried the highest mortality rate. The case fatality rate of Gram positive septicemia was higher than that of Gram negative. Patients with underlying conditions, such as malignancy, chronic liver diseases, diabetes mellitus, renal failure, heart failure and conditions requiring surgery had higher mortality rates. The chance of survival increased with the use of appropriate therapy and absence of underlying disease. None of the patients with underlying conditions survived after receiving inappropriate therapy as compared with 50% who were previously healthy. Conclusions: Factors such as patients age, type of microorganism involved, the presence of underlying disease and the appropriateness of antibiotic therapy all influence the outcome of septicemia. While some patients with an underlying condition die of the consequences of septicemia despite appropriate antimicrobial therapy, other patients without any underlying disease tolerate septicemia reasonably well.