Detection of Inflammatory Biomarkers Among Patients with Sepsis of Gram-Negative Bacteria: A Cross-Sectional Study

Abstract

Background

Sepsis is a highly mixed ailment that affects patients with numerous conditions of infectious sources and can lead to multi-organ failure with dysregulated host immune response.

Objective

To determine inflammatory biomarkers in patients with sepsis caused by Gram-negative bacteria and compare their role in the early detection of sepsis.

Methods

This cross-sectional study was conducted on patients with sepsis admitted to the intensive care unit at different hospitals in Sulaimaniyah, Iraq, from May to December 2021. Patients (n=147) were enrolled in this study according to the primary diagnosis of sepsis by Sequential Organ Failure Assessment scores. Blood samples were taken from patients to investigate white blood cells, inflammatory biomarkers (pentraxin-3, procalcitonin, adrenomedullin, lipopolysaccharide binding protein, interleukin-17A, lactate dehydrogenase, and C-creative protein), blood culture, antibiotic susceptibility test, and coagulation biomarkers (Prothrombin time, activated partial thromboplastin time, and international normalized ratio). Then, isolated Gram-negative bacteria were tested for extended-spectrum β-lactamase enzymes production by screening and combined disc tests.

Results

A total of 51.7% samples were blood culture positive for different Gram-negative bacteria, and P. aeruginosa (51.95%) was a more isolated bacterium. Both males and females were affected by sepsis in a ratio of 1.23:1 with different age groups. Extended-spectrum β-lactamase was estimated to be 77.2% by antibiotic profile, and the rate decreased using two double-disc synergy tests. This was confirmed by combined disc test at a rate of 41.35%. The most prevalent biomarkers were procalcitonin (88.16%), adrenomedullin (84.21%), pentraxin-3 (22.37%), and lipopolysaccharide binding protein (11.84%).

Conclusion

Sepsis is a life-threatening condition that can be diagnosed early by several blood biomarkers such as procalcitonin, adrenomedullin, and pentraxin-3 combined with a standard blood culture technique to improve the patient outcome.

Graphical Abstract

Keywords:

• β-Lactamase
• double-disc synergy test
• SOFA score
• sepsis biomarkers
• Gram-negative bacteria

Abbreviations

ICU, intensive care unit; MDR, multidrug-resistant bacteria; SOFA, Sequential Organ Failure Assessment; WBC, white blood cell count; PT, prothrombin time; PTT, partial thromboplastin time; INR, international normalized ratio; LBP, lipopolysaccharide binding protein; CRP, C-reactive protein; PCT, procalcitonin; PTX3, pentraxin-3; ADM, aAdrenomedullin; IL-17A, interleukin-17A; LDH, lactate dehydrogenase; MHA, Muller–Hinton agar; CLSI, Clinical and Laboratory Standards Institute; ATCC, American Type Culture Collection; CD test, combined disc test; DDST, double-disc synergy test; COVID-19, coronavirus disease 2019; ESBL, extended-spectrum β-lactamase; ELISA, enzyme linked immunosorbent assay.

Data Sharing Statement

The data used to support the findings of this study are included within the article.

Ethical Approval and Consent to Participate

The protocol of this study was accepted with the approval of the Ethics Committee from the Directorate of Health in Sulaimani, Iraq, and the local medical ethics committee of the College of Medicine, University of Sulaimani (No. 78-UoS on May 18, 2021). The participants were enrolled in the study after being informed about the procedure and providing their written consent.

Acknowledgments

The authors would like to appreciate the healthcare staff of the Dialysis Unit in Shar Teaching Hospital, Hiwa Hospital, Burn and Plastic Surgery Hospital, and Anwar Shexa Medical City, Sulaimaniyah, Iraq, and special thanks to laboratory staff of microbiology department in Shar Teaching Hospital for their kind help and assistance by providing facilities and services to this study.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was not funded by any national/international agency, company, or organization.