Sepsis Etiology Analysis In Emergency Department Of Ning Xia Medical University General Hospital

Objective: To investigate the etiology of sepsis from 2014 to 2015 in emergency department of NingXia Medical University General Hospital,so as to improve the effectiveness of empirical antibiotic therapy in patients with sepsis.Method:Sputum samples(blood,sputum,pleural effusion and ascites,cerebrospinal fluid)were collected from sepsis patients who hospitalized from January 1st,2014 to December 31 st,2015 NingXia Medical University General Hospital Emergency Department.The bacteria were identified by VITEK-2 compact automated bacterial identification system(Bio-Merieux company,French)and antimicrobial susceptibility test was carried out by means of Kirby-bauer.The results were assessed according to guidelines recommended by Committee for clinical laboratory standards(CLSI,2009-2013 version)and the data was analyzed by SPSS 17.0.Results: A total of 207 isolates were obtained from all of the 151 patients,of which gram-negative bacilli,gram-positive cocci and fungi accounted for 59.4%(123/207),29.0%(60/207)and 11.6%(24/207),respectively.The most common pathogenic bacteria were Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii,Staphylococcus aureus and Enterococcus faecium,accounting for 24.6%,12.6%,9.7%,9.7% and 9.2%,respectively.A large number of Escherichia coli was community infection strain,mainly from blood culture,100% sensitive to imipenem,community infection strain resistance were lower than the nosocomial infection strain except ampicillin-sulbactam,piperacillin-tazobactam,nitrofurantoin and imipenem.All Klebsiella pneumoniae resistant to ampicillin,and all sensitive to antibiotics except piperacillin,nitrofurantoin,fluoroquinolone antibiotics and second generation cephalosporin.Carbapenem resistant Enterobacteriaceae(CRE)were not detected.Acinetobacter baumannii and Pseudomonas aeruginosa were manly nosocomial infection strain and from sputum,Acinetobacter baumannii to most antimicrobial resistance rates were above 80%,the imipenem resistance rate has reached 95%,the detection rate of extensive drug resistant Acinetobacter baumannii(XDRAB)was 90%,the drug resistance rate to majority antibiotics is still increasing.All Staphylococcus aureus sensitive to nitrofurantoin,linezolid,quinupristin,tigecycline,teicoplanin and vancomycin,and all resistant to penicillin,the resistance rate to most antibiotics showed an increasing trend.The detection rate of methicillin resistant Staphylococcus aureus(MRSA)was 45%.All Enterococcus faecium sensitive to oxacillin,cotrimoxazole,teicoplanin,tigecycline and vancomycin,vancomycin resistant enterococci(VRE)were not detected.24 strains of fungi were Candida,which accounted for 91.7%(22/24),all Candida sensitive to flucytosine,followed by amphotericin and voriconazole,the resistant rate were 7.1%.Conclusion: Gram negative bacteria were the main pathogens isolated from patients with sepsis in our hospital,mostly from blood samples,pulmonary infection,first isolated bacteria were Escherichia coli,CRE was not detected,most Acinetobacter baumannii and Pseudomonas aeruginosa were nosocomial infection strain,and the resistance was severe.No detection of vancomycin resistant gram positive cocci,clinical need close monitoring of bacterial resistance and take various measures to slow the growth of drug resistance.