Dr Gautam Panduranga, Dr Rajesh Lekkala, Dr Faraz Farishta


Gram Negative Sepsis is an important cause of morbidity and mortality in hospital intensive care units all over the world, especially in developing countries like India. Increasing rates of antibiotic drug resistance has been noted in recent times and this adversely affects the prognosis and outcomes of patients. This study was undertaken to provide some insights into this important problem because there are very few studies on antibiotic susceptibility patterns on patients with gram negative sepsis (with positive blood cultures) in India, especially Southern India.


                      A prospective hospital based observational study was carried out to determine the antibiotic susceptibility patterns in patients with gram negative sepsis. Patients with positive blood cultures were included in the study. Outcome (in-hospital mortality) was noted. Presence of risk factors and comorbidities were also studied, including diabetes mellitus, CKD on chronic hemodialysis, HIV, COPD, Malignancy and recepients of solid organ transplant and bone marrow transplant


In our study, Diabetes mellitus was the most common risk factor. Mortality was higher in patients with one or more comorbidities. Age was an independent risk factor. Klebsiella pneumoniae was the most common organism isolated followed by Acinetobacter baumanii, Escherichia coli and Pseudomonas aeruginosa. Mortality was more in patients with Acinetobacter baumanii followed by Pseudomonas and Klebsiella, followed by E.coli (not statistically significant). Mortality in patients with cultures resistant to Meropenem was higher (statistically significant).


Among commonly used first line antibiotics in MICU, resistance to Fluoroquinolones      (Ciprofloxacin) was highest overall (two thirds were resistant). Resistance to beta lactam antibiotic (Cefoperazone sulbactam) was seen in almost half of the patients. Among ‘last resort’ broad spectrum antibiotics, Carbapenem (Meropenem) resistance was seen in approximately one third of the patients. Colistin resistance was seen in 1 in 10 patients. High resistance patterns to Meropenem, Tigecycline and Colistin is an alarming and worrisome trend.




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