Observational Study on the Occurrence, Microbiological Profile and Outcomes of Blood Culture–Positive Sepsis Patients at a Tertiary Care Hospital

Abstract

Background: Blood culture–positive sepsis is associated with significant morbidity and mortality. Understanding pathogen distribution and resistance patterns is essential for guiding empiric therapy and stewardship efforts.

Methods: This observational study was conducted at Apollo Hospital, Bhubaneswar, over 18 months, including 200 consecutive adult patients fulfilling Sepsis-3 criteria and yielding clinically significant organisms on blood culture. Demographic, clinical, microbiological and outcome data were recorded. Antimicrobial susceptibility testing followed CLSI guidelines. In-hospital mortality was the main outcome; duration of stay, ICU admission, and mechanical ventilation were the secondary outcomes.

Results: The median age was 56 years (IQR 44–67), with 62% males. Frequent sources of infection were respiratory (30%), urinary (22%) and intra-abdominal (18%). Gram-negative organisms predominated (60%), followed by Gram-positive bacteria (30%) and Candida species (10%). The most common pathogens were E. coli (25%), S. aureus (20%), K. pneumoniae (17.5%), Acinetobacter baumannii (10%) and P. aeruginosa (7.5%). MDR organisms accounted for 35% of isolates. ESBL production was detected in 40% of E. coli and 45.7% of K. pneumoniae. Carbapenem resistance was highest in Acinetobacter (70% MDR) and Klebsiella (20%). ICU admission occurred in 55% and mechanical ventilation in 40%. The median hospital stay was 12 days (IQR 8–16). Overall mortality was 30%. Higher SOFA scores, MDR infections and delayed appropriate antibiotics (>3 hours) were independently associated with mortality.

Conclusion: Gram-negative pathogens with substantial MDR prevalence predominated among culture-positive sepsis patients. Mortality remained high, driven by disease severity, antimicrobial resistance and delays in effective therapy. Early appropriate antibiotics and strengthened stewardship are essential to improve outcomes.

Keywords: ICU, IQR, MDR