Septicaemia in a general hospital

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Hospital Epidemiology

Background:

• Septicaemia (bloodstream infection) is a serious condition with significant mortality.
• Understanding the epidemiology and risk factors of septicaemia is crucial for effective patient management.
• Nosocomial infections, particularly those acquired in hospitals, represent a substantial burden.

Purpose of the Study:

• To analyze the incidence, sources, causative organisms, and outcomes of septicaemia in a large general hospital.
• To investigate the impact of antibiotic treatment regimens on mortality rates.
• To identify risk factors associated with poorer prognosis in septicaemia patients.

Main Methods:

• Retrospective analysis of 6102 blood cultures performed over a three-year period.
• Detailed examination of one-year patient records to identify sources of infection and patient demographics.
• Correlation of antibiotic treatment, patient factors (neutropenia, immunosuppression), and outcomes (mortality).

Main Results:

• Septicaemia occurred in approximately 0.5% of patients annually, with surgical wards and emergency admitting wards being the most common sources.
• Staphylococcus aureus and Escherichia coli were the most frequent pathogens identified.
• Mortality rates increased significantly with the number of antibiotics used, from 16% with one to 58% with three or more. Nosocomial infections accounted for 39% of cases with a 29% mortality rate.
• Intravenous cannulae were implicated in at least five nosocomial cases, resulting in two deaths. Neutropenia and immunosuppressive therapy were linked to worse outcomes, while body temperature and leucocyte count lacked prognostic value.

Conclusions:

• The study highlights the significant impact of septicaemia on patient outcomes, emphasizing the importance of source control and appropriate antibiotic stewardship.
• Over-treatment with multiple antibiotics is associated with a dramatically increased risk of mortality, underscoring the need for judicious antibiotic selection.
• Identifying patients with risk factors like neutropenia and immunosuppression is vital for proactive management and improved prognostication in septicaemia.