Our study aimed at assessing the prevalence of nosocomial sepsis, associated factors, bacteriological profile, drug susceptibility pattern, and outcome of patients admitted at adult ICU. The prevalence of nosocomial sepsis was 21.6% developed nosocomial sepsis. MV use and length of stay were significantly associated with the acquisition of nosocomial sepsis. The microorganisms had a broad antibiotic resistance pattern for cephalosporin, penicillin, and meropenem.
The prevalence of nosocomial sepsis in our setup was higher compared to studies done in Nigeria (15%) (8) and India (9.6%-17.7%) (7,9,10). Nosocomial sepsis happens due to inadequate hand hygiene techniques, infrequent urinary catheter changes where catheters are left in situ for a prolonged time, inadequately cleaned ventilators before and after patient use, lack of programmed ICU cleaning or decontamination procedures, and lack of strict attendant visit protocol making patients susceptible for various infections (12).
Those who were on MV had a higher risk (5.7-fold) of nosocomial sepsis. This finding was in tune with studies done in India (9,10). Also, those who stayed more than a week in the ICU had about nine times higher odds of nosocomial sepsis acquisition. This higher risk of nosocomial sepsis among those who stayed more than a week could be a result of prolonged exposer to MV use. Because, in our study, the use of MV was 64.4% in those who stayed more than a week in contrast to those who stayed a week and less, which was 16.5%. This difference was statistically significant (c2=64.3, df=1 and p<0.001). Furthermore, longer ICU stay and MV use are thought to increase the risk of acquiring antibiotic-resistant infections (12,13).
The overall mortality of ICU patients who stayed for more than 48 hours was 18.3%. But this mortality was significantly higher in those who acquired nosocomial sepsis (31.6%). Similar results, on the mortality of patients with nosocomial sepsis, are reported from studies done in Asia, Europe, and North America (10,14–17). Hence, the presence of nosocomial sepsis contributed considerably to the poor outcome of the ICU patients by increasing mortality risk significantly (p=0.003). Moreover, studies report that the burden of mortality due to nosocomial sepsis is further higher in patients with organ dysfunction and had surgery on an emergency basis (15,17).
Among the body fluid samples taken, 48 isolates of organisms were found of which 91.6% were gram-negative and 8.3% were gram-positive which are consistent with studies from Nigeria, India, and Europe (8,9,14,18). Klebsiella was found to be the commonest organism followed by pseudomonas, E. coli, and Acinetobacter. This is parallel with the studies of Nigeria, India and Fiji (8,14,18). For instance, in Fiji’s study, the commonest pathogens isolated were Klebsiella pneumoniae, Acinetobacter, and Pseudomonas (14).
Klebsiella was resistant to ampicillin, ceftazidime, cefepime in all tested isolates and showed a broad resistance pattern to other antibiotics but was found to be sensitive to meropenem in 66.7%. Pseudomonas had a sensitivity of 57.1% and 50% to ceftazidime and meropenem respectively. Higher resistance to meropenem was found in Acinetobacter, where all 4 isolates were resistant to the antibiotic. The isolated Staph. aureus was also methicillin-resistant but vancomycin sensitive. These results show that although few organisms were checked against an antibiotic, there is broad resistance to penicillin, cephalosporins, and other antibiotics. Such kind of broad resistance was announced by several studies done in ICU of different countries (19,20,29,30,21–28).
The use of antibiotics to patients should be evidence-based, when there is a highly suspected infection and bacteriologic evidence of infection. Frequent use of antibiotics in patients with or without sepsis renders most organisms to be antibiotic-resistant. When indicated, the use of antibiotics should be guided with a bacteriological profile. Providing drugs to a patient harboring resistant microorganisms results in negative impacts including financial burden, longer hospital stay, deterioration, and even death of the patient (12,13).