Bloodstream Infections Leading to Sepsis: Clinical and Microbiological Profiling of Bacteremia among Hospitalized Patients in Surabaya, Indonesia
Downloads
Introduction: Bacteremia poses a significant health risk due to its frequently atypical presentation and potential progression to sepsis. Understanding its clinical profiles and causative pathogens is essential for timely diagnosis and effective management. This study examined the characteristics of bacteremia cases in 2022 at Universitas Airlangga Hospital, Surabaya, Indonesia.
Methods: A retrospective, descriptive observational study was conducted utilizing hospitalized bacteremia patients' medical records. A total of 107 patients met the inclusion criteria, which required positive blood cultures along with complete data on age (≥19 years), sex, comorbidities, clinical manifestations, bacterial infection diagnosis, outcomes, and pathogen characteristics. Medical records failing to meet these criteria were excluded. The data were categorized and analyzed by variables.
Results: Bacteremia predominantly affected patients aged >65 years (36.4%), males (50.5%), and those with diabetes (54.2%) and with pneumonia (79.4%). Key symptoms included tachycardia (55.1%), tachypnea (55.1%), anemia (65.4%), and leukocytosis (71.0%), despite normal vitals observed in numerous cases. Gram-positive bacteria were most prevalent (69.7%), mainly Staphylococcus hominis (18.7%). Escherichia coli (9.3%) was the leading Gram-negative isolate, while extended-spectrum beta-lactamase (ESBL) strains (4.2%) were the primary multidrug-resistant organisms (MDRO). Sepsis and septic shock were equally prevalent (35.5%). Mortality (64.5%) occurred primarily due to septic shock (49.3%).
Conclusion: Sepsis and septic shock frequently occur in older males with diabetes and pneumonia. Key symptoms include frequent tachycardia, tachypnea, anemia, and leukocytosis. Septic shock, the leading cause of death in bacteremia patients, frequently occurs alongside infections by Staphylococcus hominis and ESBL-producing Escherichia coli.
Highlights:
- This study offers fresh perspectives on the clinical profiles of hospitalized bacteremia patients and the characteristics of causative bacteria at Universitas Airlangga Hospital, a topic that has been minimally explored in the Indonesian medical community.
- It highlights the prevalence of bacteremia, its clinical manifestations, and outcomes to determine the mortality rate of hospitalized bacteremia patients.
- This study provides valuable data that can help inform future infection control strategies to manage and prevent bloodstream infections, hence enhancing healthcare outcomes by emphasizing the importance of improving clinical data collection and monitoring.
Ahmed AS, Hussain E, Haleem S, Ahmed N, Latif A (2021). Epidemiology of sepsis, based on ICD-9 coding, a tertiary care experience from Pakistan. Trends in Anaesthesia and Critical Care 41: 37–46. doi: 10.1016/j.tacc.2021.08.002.
Aiesh BM, Daraghmeh D, Abu-Shamleh N, Joudallah A, Sabateen A, et al. (2023). Blood culture contamination in a tertiary care hospital: A retrospective three-year study. BMC Infectious Diseases 23(1): 448. doi: 10.1186/s12879-023-08428-0.
Arcens M, Stirnemann J, Mayor G, John G (2018). Epidemiology and strategy to prevent urinary catheters related complications. Revue Medicale Suisse 14(616): 1518–1521. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/30156786.
Bassetti M, Eckmann C, Peghin M, Carnelutti A, Righi E (2018). When to switch to an oral treatment and/or to discharge a patient with skin and soft tissue infections. Current Opinion in Infectious Diseases 31(2): 163–169. doi: 10.1097/QCO.0000000000000434.
Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R (2020). Type 2 diabetes and its impact on the immune system. Current Diabetes Reviews 16(5): 442–449. doi: 10.2174/1573399815666191024085838.
Bullock B, Benham MD (2023). Bacterial sepsis. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537054/.
Clark GK, Spier A, Nestor D, Rizzo S (2018). Bacterial endocarditis of the pulmonic valve in a dog. Journal of the American Animal Hospital Association 54(5). doi: 10.5326/JAAHA-MS-6582.
Dias SP, Brouwer MC, van de Beek D (2022). Sex and gender differences in bacterial infections. Infection and Immunity 90(10). doi: 10.1128/iai.00283-22.
Dini FN, Andayani P, Rosida L (2016). Hubungan antara masa gestasi dan kejadian sepsis neonatorum di RSUD Ulin Banjarmasin periode Juni 2014–Juni 2015. Berkala Kedokteran 12(2): 175–185. doi: 10.20527/jbk.v12i2.1865.
El-Radhi AS (2018). Pathogenesis of fever. In: Clinical Manual of Fever in Children. Cham: Springer International Publishing. doi: 10.1007/978-3-319-92336-9_3.
Goulart DB (2023). Pathogenicity and antimicrobial resistance in coagulase-negative staphylococci. Journal of Biosciences and Medicines 11(05): 9–29. doi: 10.4236/jbm.2023.115002.
Hess S (2023). [18F]FDG-PET/CT in patients with bacteremia: Clinical impact on patient management and outcome. Frontiers in Medicine 10. doi: 10.3389/fmed.2023.1157692.
Hu H, Mei J, Lin M, Wu X, Lin H, et al. (2022). The causal relationship between obesity and skin and soft tissue infections: A two-sample Mendelian randomization study. Frontiers in Endocrinology 13. doi: 10.3389/fendo.2022.996863.
Jin X, Marshall JS (2020). Mechanics of biofilms formed of bacteria with fimbriae appendages. PLoS ONE 15(12): e0243280. doi: 10.1371/journal.pone.0243280.
La Via L, Sangiorgio G, Stefani S, Marino A, Nunnari G, et al. (2024). The global burden of sepsis and septic shock. Epidemiologia 5(3): 456–478. doi: 10.3390/epidemiologia5030032.
Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, et al. (2012). Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Critical Care Medicine 40(3): 754–761. doi: 10.1097/CCM.0b013e318232db65.
Larasati SA, Windria S, Cahyadi AI (2020). Virulence factors of Staphylococcus aureus which play an important role in the occurrence of mastitis in dairy cattle: A literature review. Indonesia Medicus Veterinus 9(6): 984–999. doi: 10.19087/imv.2020.9.6.984.
Lee CC, Wang JL, Lee CH, Hung YP, Hong MY, et al. (2017). Age-related trends in adults with community-onset bacteremia. Antimicrobial Agents and Chemotherapy 61(12). doi: 10.1128/AAC.01050-17.
Lee DS, Lee SJ, Choe HS (2018). Community-acquired urinary tract infection by Escherichia coli in the era of antibiotic resistance. BioMed Research International 2018: 1–14. doi: 10.1155/2018/7656752.
Mansyoer R, Widjaja IR (2017). Pola kuman dan uji kepekaan antibiotik pada pasien unit perawatan intensif anak di Rumah Sakit Umum Daerah Koja, Jakarta. Sari Pediatri 19(2): 103–107. doi: 10.14238/sp19.2.2017.103-7.
Martin-Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, et al. (2019). Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: A prospective, observational, multicenter cohort study. Annals of Intensive Care 9(1): 26. doi: 10.1186/s13613-019-0495-x.
Microsoft Inc. (2016). Microsoft Excel for Windows, version 16.0. Redmond, WA, USA: Microsoft Inc. Retrieved from https://learn.microsoft.com/en-us/officeupdates/current-channel.
Minasyan H (2019). Sepsis: Mechanisms of bacterial injury to the patient. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 27(1): 19. doi: 10.1186/s13049-019-0596-4.
Ministry of Health of the Republic of Indonesia (2017). Decree of Minister of Health of the Republic of Indonesia no. HK.01.07/Menkes/342/2017 concerning National Guidelines for Medical Services in the Management of Sepsis. Retrieved from http://hukor.kemkes.go.id/uploads/produk_hukum/KMK_No._HK_.01_.07-MENKES-342-2017_ttg_Pedoman_Pelayanan_Kedokteran_Tata_Laksana_Sepsis_.pdf.
Muslimin D, Majid MN, Effendi NI, Simarmata N, Ristiyana R, et al. (2023). Metodologi penelitian kuantitatif dan kualitatif. (N. Mayasar & Yuliatri, Eds.). Padang: Get Press Indonesia. Retrieved from https://eprints.machung.ac.id/2406/1/04.1._Anna_BOOK_CHAPTER_Validitas_dan_Reliabilitas_dalam_Penelitian_Kualitatif.pdf.
Nainggolan JJP, Kumaat LT, Laihad ML (2017). Gambaran sumber terjadinya infeksi pada penderita sepsis dan syok septik di ICU RSUP Prof. Dr. R. D. Kandou Manado periode Agustus 2016 sampai dengan September 2017. E-CliniC 5(2): 300–304. doi: 10.35790/ecl.5.2.2017.18570.
Pairunan JN, Runtunuwu AL, Salendu PM (2016). Hubungan pemeriksaan hitung darah lengkap pada anak dengan sepsis. E-CliniC 4(1): 76–81. doi: 10.35790/ecl.4.1.2016.10835.
Ponce D, Nitsch D, Ikizler TA (2023). Strategies to prevent infections in dialysis patients. Seminars in Nephrology 43(5): 151467. doi: 10.1016/j.semnephrol.2023.151467.
Purba AKR, Mariana N, Aliska G, Wijaya SH, Wulandari RR, et al. (2020). The burden and costs of sepsis and reimbursement of its treatment in a developing country: An observational study on focal infections in Indonesia. International Journal of Infectious Diseases 96: 211–218. doi: 10.1016/j.ijid.2020.04.075.
Riwu KHP, Effendi MH, Rantam FA, Khairullah AR, Widodo A (2022). A review: Virulence factors of Klebsiella pneumonia as emerging infection on the food chain. Veterinary World 15(9): 2172–2179. doi: 10.14202/vetworld.2022.2172-2179.
Rosita L, Husodo AC (2015). The relationship of sepsis occurrence and the reduction of platelet count: A research in PKU Muhammadiyah Yogyakarta Hospital for the period of January to December 2010. Journal of Health, Medicine and Nursing 17(Special Issue for International Conference of Medical and Health Sciences 2015): 26–31. Retrieved from https://iiste.org/Journals/index.php/JHMN/article/view/25369.
Sipilä PN, Lindbohm J V., Batty GD, Heikkilä N, Vahtera J, et al. (2023). Severe infection and risk of cardiovascular disease: A multicohort study. Circulation 147(21): 1582–1593. doi: 10.1161/CIRCULATIONAHA.122.061183.
Srzić I (2022). Sepsis definition: What’s new in the treatment guidelines. Acta Clinica Croatica 61(Supplement 1): 67–72. doi: 10.20471/acc.2022.61.s1.11.
Suarmayasa IN (2023). Pola kuman pada manset sphygmomanometer: Studi deskriptif di RSD Mangusada. Jurnal Riset Kesehatan Nasional 7(2): 163–168. doi: 10.37294/jrkn.v7i2.481.
Subhaktiyasa PG (2024). Menentukan populasi dan sampel: Pendekatan metodologi penelitian kuantitatif dan kualitatif. Jurnal Ilmiah Profesi Pendidikan 9(4): 2721–2731. doi: 10.29303/jipp.v9i4.2657.
Tambajong RN, Lalenoh DC, Kumaat L (2016). Profil penderita sepsis di ICU RSUP Prof. Dr. R. D. Kandou Manado periode Desember 2014 – November 2015. E-CliniC 4(1): 452–457. doi: 10.35790/ecl.4.1.2016.11011.
Toyyibah ID, Rusli M, Juniastuti (2022). Bacterial pattern among sepsis patients in internal medicine inpatient ward Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Majalah Biomorfologi 32(2): 52–58. doi: 10.20473/mbiom.v32i1.2022.52-58.
Uhlenhopp D, Sunkara T, Westerly B, Gaduputi V (2020). A rapidly fatal case of fulminant hepatic failure from Streptococcus salivarius bacteremia. American Journal of Gastroenterology 115(1): S1299–S1299. doi: 10.14309/01.ajg.0000711856.91947.2d.
Vilcant V, Hai O (2023). Bacterial endocarditis. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470547/.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, et al. (2006). Sepsis in European intensive care units: Results of the SOAP study. Critical Care Medicine 34(2): 344–353. doi: 10.1097/01.CCM.0000194725.48928.3A.
Yamashiro Y, Nomoto K (2017). Bacteremia and probiotics: A novel culture-independent analytical method evolves disease concepts. Annals of Nutrition and Metabolism 71(Suppl. 1): 1–3. doi: 10.1159/000479916.
Zhou H, Li Z, Liang H, Yan Z (2022). Thrombocytopenia and platelet count recovery in patients with sepsis-3: A retrospective observational study. Platelets 33(4): 612–620. doi: 10.1080/09537104.2021.1970124.
Copyright (c) 2025 Nuritsna Marwasyifa, Tri Pudy Asmarawati, Firman Setiawan, Pepy Dwi Endraswari
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) Author
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions.
3. The formal legal aspect of journal publication accessibility refers to Creative Commons Atribution-Share Alike 4.0 (CC BY-SA).
