Microbiology profile of sepsis in Brazil

Introduction

Sepsis occurs in 16.6% of the patients in the Brazilian ICU and is associated with a high mortality rate (46.6%). Several studies show different pathogenic agents among countries and increased antibiotic resistance. This study aims to describe the pathogen profile in Brazil's ICU septic patients.

Methods

A prospective cohort study involving 75 ICUs all over Brazil was performed. All patients who were admitted or developed sepsis during a 1-month period were enrolled and followed until the 28th day and/or until their discharge.

Results

A total of 521 patients filled the criteria of sepsis and were studied. The two main sources of infection were pneumonia and the abdominal tract. Gram-negative bacteria were isolated in 40.1%, followed by Gram-positive (38.8%) and fungus (5%). The most prevalent bacteria were Staphylococcus aureus (31.3%) and Pseudomonas aeruginosa (26.8%). Methicilin-resistant Staphylococcus aureus (MRSA) were present in 64.8%. Bacteria were isolated in blood samples in 19.57% and S. aureus was prevalent. The prevalence of antimicrobial-resistant bacteria was 26.6% and was associated with higher mortality at the 28th day (resistant bacteria 50.9% vs nonresistant bacteria 43.5%). Septic shock was related to the highest mortality, with rates ranging from 45.8%, 63.7% and 83.3% due to S. aureus, P. aeruginosa and Acinetobacter spp, respectively.

Conclusion

Gram-negative bacteria were the most frequently isolated pathogens in the ICU in septic patients. MRSA represented the majority of S.aureus strains isolated. Antibiotic-resistant bacteria were associated with higher mortality. It is important to recognize the Brazilian ICU organisms' profile and their resistance pattern to guide rational administration of antimicrobial agents.