Antimicrobial therapy and outcome of septicemia patients admitted to a University Hospital in Delhi.

Abstract

Septicemia is a common clinical condition encountered in most of the hospitals in this region of the world. However, limited information is available in the Indian literature on antimicrobial usage in patients with suspected or proven cases of septicemia. The aim of the present study is on the one hand to describe the clinical characteristics of septicemia, the causative pathogens, the current pattern of antimicrobial use, the clinical outcome, the acquisition cost of commonly used antimicrobial regimens and on the other hand to monitor adverse drug reactions (ADRs) during therapy of septicemia patients admitted to a University Hospital in Delhi. We prospectively reviewed the antimicrobial therapy in 34 clinically diagnosed septicemia cases admitted to a University Hospital from July 2009 to December 2009. All study patients presented various clinical signs and symptoms, fever, diarrhoea and vomiting were most commonly reported. Microorganisms could be identified in 13 (38.2%) of the patients. Escherichia coli (41.2%) constituted the most prevalent bacterial pathogen. Among culture positive patients, 15.4% received ceftriaxone as the most common empirical antimicrobial therapy; among culture negative patients, 19% received cefotaxime plus amikacin as the most common empirical antimicrobial therapy. The average acquisition cost of the 1st line antimicrobial regimen was higher in culture positive than in culture negative patients, but it was reversed for the 2nd line therapy. Overall, 67.6% patients were discharged after recovery, 23.5% were transferred out and 8.8% died during the course of therapy. 9 (26.5%) patients experienced ADRs during the antimicrobial therapy. These findings may have an important implication for developing comprehensive, evidence-based guidelines for the practical treatment of septicemia, adherence to which may lead to a more rational antimicrobial therapy, to cost reduction and to an improved level of care of patients with septicemia.