Title: Bacteriological Profile and Antimicrobial Susceptibility of Blood Culture Isolates from Tertiary Care Hospital, Navi Mumbai

Authors: Jyoti P.Sonawane, N.Kamath, Keertana Shetty, Rita Swaminathan

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i10.35

Abstract

 Introduction:  Blood stream infections (BSI) constitute a significant public health problem with increasing morbidity and mortality in hospitalized patients. Illnesses associated with blood-stream infections range from self-limiting infections to life threatening sepsis and require rapid and aggressive antimicrobial treatment. Again with the emergence of Multi-drug resistant organisms, there is increased risk of death in these patients.

Aim & Objective: The present retrospective study was undertaken to know the profile of organisms causing bacteraemia with their antibiogram from clinically suspected cases of bacteraemia.

Materials and Methods: Reports from the blood cultures submitted during the period of one year were analysed. 2994 blood culture samples were received to the microbiology laboratory. The bacterial isolates from positive cultures were identified by standard protocols and antimicrobial sensitivity patterns were determined by CLSI guidelines.

Results: Positive blood cultures were obtained in 10.29 % (308/2994).  Of 308 positive cultures, bacterial isolates were obtained in 286/ 308 (92.86%) and 22/308 (7.14%) were Candida spp. Of 286 bacterial isolates, Gram- negative bacteria accounted for 238 (83.22%) cases and Gram-positive were 48(16.78%) with predominance of Klebsiella spp. (22.38%) followed by Pseudomonas spp. (20.98%), Acinetobacter spp. (17.48%) an E.coli 32(11.19%).

Among Enterobactericae, the high % of ESBL production was seen in Klebsiella aeruginosa (55.66%) and in E.coli (29.24%), with highest sensitivity to Imipenem (97.66%), Amikacin (60.16%) and Piperacillin-tazobactum (52.34%). All showed 100% sensitivity to colistin. Among non-fermenters, Imipenem sensitivity was (91.82%) followed by Piperacillin-tazobactum sensitivity (67.27%) & Amikacin sensitivity was (50%). Colistin showed (94.55%) sensitivity. Among Gram-positive isolates (16.78%), Enterococcus spp. were (7.66%) followed by Staphylococcus aureus (6.97%). MRSA was seen in 10% of S.aureus isolates. All Gram-positive isolates showed (100%) sensitivity to Vancomycin and Linezolid.

Conclusion: The present study provides information on the most prevalent pathogens from blood cultures along with their sensitivity towards commonly used antimicrobials. The Majority of bacterial isolates were multidrug resistant. Thus providing useful guide to clinicians in initiating empiric therapy and will also help in formulation of antibiotic policy.

Keywords: Blood stream infections, ESBL, Multidrug resistant bacteria, Antibiotic policy.  

References

1.      Elmer Koneman, Washington C. Winn, jr., Stephen allen,William janda et al. Konem-an s color atlas and textbook of diagnostic microbiology, 6th edition. Page no.97.

2.      P.A.Fuselier, L.S.Garcia, G.W. Procop et al., “Blood stream infections,” in Bailey and Scott’” s Diagnostic microbiology, A.F. Betty, F.S. Daniel and S.W.Alice, Eds., pp. 865-883, Mosby,2002.

3.      Young LS. Sepsis syndrome. In: Mandell GL, Bennet JE, Dolin R,editors. Principle and Practice of Infectious Diseases. Elsevier:Churchill Livingstone; 1995. p. 690-705.

4.      Daniel RK,Scott AF,James MB,Sanjay S (2006).Brief Report on Incidence, etiology, risk factors and outcome of Hospital acquired fever. J Gen Intern Med 21: 1184-1187.

5.      Tziamabos A O, Kasper D L (2005) Principle and Practice of Infectioous  Diseases.Frank Polizano J,26 : 2810-2816.

6.      Kalpesh Gohel, Amit Jojera, Shailesh Soni, Sishir Gang,Ravindra Sabnis, and Mahesh Desai Bacteriological Profile and Drug Resistance Patterns of Blood Culture Isolates in a Tertiary Care Nephrourology Teaching Institute BioMed Research International, Volume 2014,  Article ID 153747, 5 pages, 2014, doi: 10.1155/2-014/153747.

7.      Vanitha RN, Kannan G, Venkata NM, Vishwakanth D, Nagesh VR,Yogitha M, et al. A retrospective study on blood stream infectionsand antibiotic susceptibility patterns in a tertiary care teachinghospital. Int J Pharm Pharm Sci 2012; 4:5438.

8.      Shilpi Gupta, Bineeta Kashyap. Bacteriological profile and antibiogram of blood culture isolates from a tertiary care hospital of North India. Tropical J. Medical research.Vol.19.Issue.2.Jul-Dec 2016, 94-99.

9.      Warren DK, Zack JE, Elward AM, Cox MJ, Fraser VJ. Nosocomial primary bloodstream infections in intensive care unit patients in a nonteaching community medical center: A 21month prospective study. Clin Infect Dis 2001; 33:132935.

10.  Karunakaran R, Raja NS, Ng KP, Navratnam P. Etiology of blood culture isolates among patients in a multidisciplinary teaching hospital in Kuala Lumpur. J Microbiol Immunol Infect 2007; 40; 432-437.

11.  Cruickshank K, Duguid JP, Marmion BP. Test for sensitivity to microbial agents. In: Medical Microbiology. Chuchill Livingstone, 1980; 190-209.

12.  Cheesbrough, M. District laboratory practice in tropical countries.2. Vol.2. Cambridge, UK : Cambridge University press;2000.p.124-5.

13.  Murray, B; Pfaller, T.Manual of Clinical Miceobiology.6. American Society of Microbiology Press; Washington DC: 1999.

14.  Clinical and Laboratory Standards Institute (CLSI). 20 th Informational Supplement. Wayne, PA: CLSI; 2012. Performance Standards for Antimicrobial Susceptibility Testing. CLSI document M100-S20.

15.  Manjula M, Pyria D, Varsha G: Antimicrobial susceptibility pattern of blood isolates from a teaching Hospital in north India. Japan J Infec Dis 2005, 58:174 176.

16.  Usha A, Pushpa D (2007) Bacterial profile of bloodstream infections and antibiotic resistance pattern of isolates. J K Sci 9(4):186-190.

17.  Mehta M, Dutta P, Gupta V. Antimicrobial susceptibility patternof blood isolates from a teaching hospital in north India.Jpn.J. Infect Dis 2005; 58:1746.

18.  Shalini S, Kranthi K, Gopalkrishna BK. The microbiological profile of nosocomial infections in the intensive care unit. J Clin Diagn Res 2010; 4: 3109-12.

19.  Hamed Ghadiri,1 Hamid Vaez,2 Samira Khosravi,3 and Ebrahim Soleymani3.The Antibiotic Resistance Profiles of Bacterial Strains Isolated from Patientswith Hospital-Acquired Bloodstream and Urinary Tract Infections. Critical Care Research and Practice Volume 2012, Article ID 890797.

20.  Khanal B, Harish BN, Sethuraman KR, Srinivasan S. Infective endocarditis: Report of a prospective study in an Indian hospital.Trop Doct 2002; 32:835

21.  Arora U, Devi P. Bacterial profile of blood stream infections and antibiotic resistance pattern of isolates. J K Sci 2007; 9:18690.

22.  Garg A, Anupurba S, Garg J, Goyal RK, Sen MR. Bacteriologicalprofile and antimicrobial resistance of blood culture isolatesfrom a university hospital. J Indian Acad Clin Med 2007; 8:13943.

23.  Nidhi Pal and Ramamurthy Sujatha, Microbiological Profile and Antimicrobial Resistant Pattern of Blood Culture Isolates, Among Septicaemia Suspected Patients. National Journal of Laboratory Medicine. 2016 Jan, Vol 5(1): 17-21.

24.  Ali J, Kebede Y. Frequency of isolation and antimicrobial susceptibility pattern of bacterial isolates from blood culture, Gondar University teaching hospital, Northwest Ethiopia. Ethiop Med J. 2008; 46(2):155–61.

25.  Araya G.Wasihun, Letemichael N. Wlekidan, Senay A. Gebremariam, Tsehaye A. Dejene A. L. Welderrufael, T. D. Haile and saravanan Muthupand-ian.Bacteriological profile and antimicro-bnial patterns of blood culture isolates among febrile patients in Mekelle Hospital, Northern Ethiopia. SpringerPlus (2015)4 : 314 .

26.  Philip CH, Charles OO, Usman NAI, Ousman S, Samual A, Naomi S et al (2007) Bacteremia in patients admitted to an urban hospital in west Africa.BMC Infect Dis 7(2): 1-8.

27.  Dagnew M, Yismaw G et al. Bacterial profile and antimicrobial susceptibility pattern in septicemia suspected patients attending Gondar University Hospital, Northwest Ethiopia. BMC Res Notes. 2013; 6: 283.

28.  Mathur P, Varghese P, Tak V, Gunjiyal J,Lalwani S, Kumar S, Misra MC. Epidemiology ofblood stream infections at a level-1 trauma care center of India. J Lab Physicians 2014; 6:22-7.

29.  Sharma PP, Halder D, Dutta AK, Dutta R,Bhatnagar S, Bali A et al. Bacteriolo-gical profile of neonatal septicemia. Indian Pediatr J 1987; 24:1011-7.

30.  I. Roy, A. Jain, M. Kumar, and S. K. Agarwal, “Bacteriology of neonatal septicemia in a tertiary care hospital of Northern India,” Indian Journal of Medical Microbiology, vol. 20, pp. 156–159, 2002.

31.  Devi V, Sahoo B, Damrolien S, Praveen S, Lungran P, Devi M.A study on the bacterial profile of bloodstream infections inRims Hospital. J Dent Med Sci 2015;14:1823.12.

32.  Chhina D, Gupta V. Bacteriological profile and antimicrobialsusceptibility pattern of Blood isolates from a tertiary carehospital in North India. IJPRBS 2013;2:2435.

33.  Asrat D, Amanuel YW. Prevalence and antibiotic susceptibility [30]pattern of bacterial isolates from blood culture in Tikur Anbassa Hospital, Addis Ababa, Ethiopia. Ethiop Med J. 2001; 39(2):97-104.

34.  Leonid M Irenge, Landry Kabego, Faustin B Kinunus, Rapheal B Chirimwami. Antimicrobial resistance of bacteria isolated from patients with bloosstream infections at a tertiary care hospital in the Democratic Republic of the Congo. SAMJ.Sept.2015, Vol.105, No.9; 752-755.

35.  Ghanshyam DK, Ramachandram VC, Piyush G. Bacteriological analysis of blood culture. Malaysian J Microbio. 2008; 4(Suppl 2):51–61. 30

36.  Poirel I,Revathi G, Bernabeu S, et al.Detection of NDM I producing Kleibsiella pneumonia in Kenya. Antimicrob Agents Chemother 2011;55 (2):934-936.

37.  Datta S, Wattal C, Goel N, J.K. Raveendran, Prasad K.J.(2012) “ A ten year analysis of Multi-drug resistant Blood stream infections caused by E.coli & Klebsiella pneumonia in a tertiary care hospital,” Indian Journal of Medical Reasearch, 135 (6)907-12.

Corresponding Author

Dr N.Kamath

Dept of Microbiology

D Y Patil Medical College & Hospital, Nerul, Navi Mumbai

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile No. : 9769350033/ 9967587087