Infectious Profile Of Patients With Sepsis In The Intensive Care Unit Of The “San Francisco Xavier” University Hospital In The City Of Sucre. 2019 - 2022.

Abstract

INTRODUCTION: Sepsis is one of the main causes
of admission and mortality in Intensive Care Units
(ICUs) worldwide, with particularly high morbidity
and mortality when associated with multidrugresistant microorganisms [1–3]. In Bolivia, the
availability of local data on sepsis and antimicrobial
resistance is limited, hindering the development
of evidence-based management guidelines [4,9].
OBJECTIVE: To describe the infectious profile
of patients over 18 years of age with sepsis in
the ICU of Hospital Universitario “San Francisco
Xavier” (Sucre, Bolivia) between 2019–2022,
and to analyze the relationship between mortality
and antimicrobial resistance mechanisms (ESBL,
carbapenemases, and resistance to methicillin
and vancomycin). METHODS: An observational,
descriptive, and retrospective study was conducted,
with an analytical case-control component for the
association between mortality and antimicrobial
resistance. We included 207 medical records of septic
patients (clinically or microbiologically confirmed).
Sociodemographic data, sites of infection, isolated
microorganisms, antimicrobial resistance patterns,
and discharge status (survived/deceased) were
collected. Frequencies, percentages, and odds
ratios (OR) with a 95% confidence interval (95% CI)
were calculated, considering p<0.05 as significant.
RESULTS: Female sex predominated (56.04%),
with 53.14% of patients older than 65 years.
Overall lethality was 47.82%. The main infection
sites were renal–urological (29.95%), respiratory
(16.90%), and gastrointestinal (16.42%). A total of
42.57% of cases were classified as nosocomial.
Escherichia coli (35.74%), Staphylococcus aureus
(18.84%), and Pseudomonas aeruginosa (12.07%)
were the leading etiologies. Among Gramnegative bacteria, 45.41% presented ESBL and
8.69% carbapenemases. There was a significant
association between mortality and the presence of
ESBL (OR=7.79; p=0.00001) and carbapenemases
(OR=11.13; p=0.000128). CONCLUSIONS: Sepsis
in the analyzed ICU predominantly affects older
adults and shows a high prevalence of Gramnegative pathogens with high resistance rates
(ESBL, carbapenemases), which was associated
with higher lethality. These findings underscore the
importance of infection control protocols and the
optimization of antimicrobial use, aligned with global
strategies to reduce the burden of sepsis [5,8,10].