Appropriateness of diagnosis and antibiotic use in sepsis patients admitted to a tertiary hospital in Indonesia

Figures & data

Figure 1. Flow chart for patient inclusion

ICD-10: International Classification of Diseases, version 10; SSC: Survival Sepsis Champaign; SIRS: Systemic Inflammatory Response Syndrome; CRF: Chronic Renal Failure

Table 1. Patient characteristics

	ICU n = 150		Non-ICU n = 385		Community-acquired n = 295		Hospital acquired* n = 240
	n	%	n	%	n	%	n	%
Age group
17–24	5	3.3	20	5.2	12	4.1	13	5.4
25–34	12	8.0	53	13.8	33	11.2	32	13.3
35–44	21	14.0	50	13.0	37	12.5	34	14.2
45–54	31	20.7	94	24.4	69	23.4	56	23.3
55–64	45	30.0	86	22.3	75	25.4	56	23.3
65≥	36	24.0	82	21.3	69	23.4	49	20.4
Gender
Female	63	42.0	153	39.7	131	44.4	85	35.4
Male	87	58.0	232	60.3	164	55.6	155	64.6
Charlson index
0–3	61	40.7	187	48.6	131	44.4	117	48.7
4–7	77	51.3	173	44.9	149	50.5	101	42.1
8–11	11	7.3	23	6.0	14	4.8	20	8.3
≥12	1	0.7	2	0.5	1	0.3	2	0.8
Focus of infection**
Pneumonia	104	69.3	275	71.4	217	73.6	162	67.5
Urinary tract infection	38	25.3	81	21.0	56	19.0	63	26.3
SSTI	25	16.7	62	16.1	49	16.6	38	15.8
IAI	11	7.3	26	6.8	15	5.1	22	9.2
Other	16	10.7	63	16.4	37	12.5	42	17.5

* > 48 hours after admission diagnosed; ** multiple foci per patient possible; ICU: Intensive Care Unit; SSTI: Skin and soft tissue infection IAI: intra-abdominal infection;

Table 2. Management and appropriateness of antibiotic treatment of patients with sepsis

	ICU n = 150		Non-ICU n = 385		Community acquired n = 295		Hospital acquired* n = 240
	n	%	n	%	n	%	n	%
Empirical antibiotic treatment given during admission	150	100	381	99.0	293	99.3	238	99.2
Culture performed (at least one)	116	77.3	276	71.7	187	63.4	205	85.4
Blood culture performed	87	58.0	182	47.3	142	48.1	127	52.9
Growth in blood culture	28	32.2	46	25.3	39	27.5	35	27.6
Antibiotic treatment given at diagnosis	148	98.7	377	97.9	292	99.0	233	97.1
Appropriateness of antibiotic treatment at diagnosis**	n = 148		n = 377		n = 292		n = 233
Definite^#	6	4.1	12	3.2	10	3.4	8	3.4
Probable^†	13	8.9	35	9.3	21	7.2	27	11.6
Inappropriate^$	57	38.5	145	38.5	71	24.3	131	56.2
Unknown^¶	72	48.7	185	49.1	190	65.1	67	28.8

ICU: Intensive Care Unit; * > 48 hours after admission diagnosed

** patients not starting antibiotics at sepsis diagnosis are excluded (n = 10)

^#the administration of antibiotics for which all micro-organisms identified in blood cultures are susceptible;

^†In the absence of a positive blood culture, if all micro-organisms identified in any other culture are susceptible;

^$the administration of antibiotics for which none of the micro-organism identified in blood cultures, or any other cultures (in the absence of blood culture) is susceptible.

no positive culture, or no cultures are performed.

Table 3. Antibiotic treatment, empirical and at sepsis diagnosis

	Empirical antibiotic treatment								Antibiotic treatment at time of sepsis diagnosis
	ICU n = 150		Non-ICU n = 385		Community acquired n = 295		Hospital acquired* n = 240		ICU n = 150		Non-ICU n = 385		Community acquired n = 295		Hospital acquired* n = 240
	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
No antibiotics	0	0	4	1.0	2	0.7	2	0.8	2	1.3	8	2.1	3	1.0	7	2.9
From 1 class	49	32.7	125	32.5	90	30.5	84	35.0	44	29.3	99	25.7	69	23.4	74	30.8
From 2 classes	64	42.7	179	46.5	138	46.8	105	43.8	59	39.3	171	44.4	133	45.1	97	40.4
From 3 classes	30	20.0	70	18.2	57	19.3	43	17.9	38	25.3	85	22.1`	73	24.8	50	20.8
From 4 classes	6	4.0	7	1.8	8	2.7	5	2.1	7	4.7	20	5.2	15	5.1	12	5.0
From 5 classes	1	0.7	0	0	0	0	1	0.4	0	0	2	0.5	2	0.7	0	0
Antibiotic (Class)
Fluoroquinolone	67	44.7	156	40.5	149	50.5	74	30.8	68	45.3	170	44.1	160	54.2	78	32.5
Cephalosporin	129	86.0	344	89.4	256	86.8	217	90.4	111	74.0	334	86.8	245	83.1	200	83.3
Aminoglycoside	14	9.3	64	16.6	42	14.2	36	15.0	17	11.3	89	23.1	59	20.0	47	19.6
Macrolide	5	3.3	10	2.6	4	1.4	11	4.6	5	3.3	14	3.6	7	2.4	12	5.0
Lincosamides	1	0.7	7	1.8	4	1.4	4	1.7	1	0.7	7	1.8	4	1.4	4	1.7
Folate Pathway Inhibitor	1	0.7	31	8.1	18	6.1	14	5.8	1	0.7	32	8.3	20	6.8	13	5.4
Carbapenem	55	36.7	36	9.4	54	18.3	37	15.4	73	48.7	53	13.8	77	26.1	49	20.4
Metronidazole	21	14.0	62	16.1	40	13.4	43	17.9	22	14.7	69	1.9	47	15.9	44	18.3
Tetracycline	1	0.7	5	1.3	2	0.7	4	1.7	1	0.7	5	1.3	2	0.7	4	1.7
Glycopeptide	1	0.7	2	0.5	0	0	3	1.3	2	1.3	3	0.8	0	0	4	2.1
Penicillin	1	0.7	2	0.5	0	0	5	2.1	1	0.7	3	0.8	0	0	4	1.7

* > 48 hours after admission diagnosed; ICU: Intensive Care Unit;

Figure 2. Appropriateness of antibiotic treatment at the diagnosis of sepsis