Nuritsna Marwasyifa, Tri Pudy Asmarawati, Firman Setiawan, Pepy Dwi Endraswari

Bloodstream Infections Leading to Sepsis: Clinical and Microbiological Profiling of Bacteremia among Hospitalized Patients in Surabaya, Indonesia

Introduction

Bloodstream infections leading to sepsis: clinical and microbiological profiling of bacteremia among hospitalized patients in surabaya, indonesia. Clinical & microbiological profiles of bacteremia and sepsis in Surabaya's hospitalized patients. Reveals common pathogens (Staphylococcus hominis, E. coli), risk factors, & high mortality to inform infection control.

Abstract

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: 1. 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. 2. It highlights the prevalence of bacteremia, its clinical manifestations, and outcomes to determine the mortality rate of hospitalized bacteremia patients. 3. 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.

Review

This study, "Bloodstream Infections Leading to Sepsis: Clinical and Microbiological Profiling of Bacteremia among Hospitalized Patients in Surabaya, Indonesia," addresses a critically important public health challenge. By profiling bacteremia cases in a specific tertiary hospital in Indonesia, the authors fill a significant knowledge gap, as local data on this topic are scarce. Understanding the clinical characteristics and causative pathogens of bloodstream infections is fundamental for improving diagnostic timeliness, guiding empirical antimicrobial therapy, and ultimately reducing the morbidity and mortality associated with sepsis, which remains a leading cause of death globally. The study's focus on a minimally explored area within the Indonesian medical community makes its findings particularly relevant for local clinical practice and policy. The authors employed a retrospective, descriptive observational study design, analyzing medical records of 107 hospitalized patients with positive blood cultures. The detailed characterization of patient demographics, comorbidities, clinical manifestations, microbiological profiles, and outcomes provides valuable insights. Key findings include the predominance of bacteremia in older males with diabetes and pneumonia, and the frequent presentation with tachycardia, tachypnea, anemia, and leukocytosis, alongside the notable observation of normal vitals in a number of cases, which underscores diagnostic complexities. Microbiologically, Gram-positive bacteria, especially *Staphylococcus hominis*, were most common, with *Escherichia coli* being the leading Gram-negative isolate, including concerning ESBL strains. The high prevalence of sepsis and septic shock, coupled with an alarming 64.5% mortality rate primarily due to septic shock, emphasizes the severe impact of these infections in the studied population. While providing a crucial baseline, the study's retrospective, single-center, and descriptive nature inherently limits the generalizability of its findings and the ability to infer causal relationships. Future research could benefit from prospective designs, broader geographical representation across multiple hospitals, and a more in-depth analysis of risk factors contributing to specific pathogen acquisition or adverse outcomes. Despite these limitations, this study offers essential data that can immediately inform local empirical antibiotic guidelines, strengthen infection control strategies, and enhance clinical suspicion for bacteremia, even in cases with atypical presentations. The emphasis on improving clinical data collection and monitoring is a vital call to action, ultimately paving the way for improved management and prevention of bloodstream infections and sepsis in Indonesia.

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