A proposed management pathway for community-acquired Gram-negative sepsis in Chinese older adults

Abstract

Introduction: Sepsis epidemiology varies regionally. We aimed to characterise community-acquired sepsis in Chinese older adults and develop an evidence-based, cost-effective empirical therapeutic pathway tailored to local antimicrobial-resistance patterns.

Methods: This single-centre, retrospective observational cohort study conducted at a tertiary hospital in Shanghai, China, enrolled 122 consecutive older adults (age ≥ 65 years) meeting Sepsis-3 criteria between June 2021 and May 2023. Microbiological data, antimicrobial-susceptibility profiles, clinical characteristics, and 28-day all-cause mortality were analysed. Multivariate logistic regression was used to identify independent risk factors for mortality.

Results: Gram-negative bacteria predominated (54.9%) and showed high susceptibility to cefoperazone-sulbactam (85.0%). The 28-day mortality rate was 37.7%. Multivariate analysis identified increasing age (adjusted odds ratio [aOR] = 1.10 per year), need for intensive care unit admission (aOR = 6.65), mechanical ventilation (aOR = 5.78), and dialysis (aOR = 3.62) as independent predictors of mortality. Notably, adequate empirical antimicrobial therapy was not an independent protective factor in the adjusted model. A cost-effective clinical pathway with cefoperazone-sulbactam as the first-line empirical therapy and escalation based on clinical response was developed for use in resource-limited settings.

Conclusions: The findings underscore the dominance of Gram-negative pathogens and the critical influence of host factors on survival among older adults with sepsis in China. They also provide a carbapenem-sparing, pragmatic, and sustainable management pathway for initial sepsis treatment in resource-limited settings, which can be replicated for antimicrobial stewardship in other regions with similar epidemiological profiles. The clinical effectiveness of this hypothesis-generating pathway requires validation in prospective, multicentre studies..