Study of prevalence and antimicrobial susceptibility pattern of blood culture isolates from a tertiary care hospital of North India
Keywords:Blood stream infections, Bacterial isolates, Critical care units, Multi-drug resistance
Background: Bacterial bloodstream infections (BSIs) are important causes of morbidity and mortality world-wide. The choice of antimicrobial therapy for bloodstream infections is often empirical and based on the knowledge of local antimicrobial activity profiles of the most common bacteria causing such infections. The objective of the study was to determine the pattern of bacterial isolates from the blood cultures in a teaching hospital and determine their antibiotic resistance and provide guidelines for choosing an effective antibiotic therapy in cases of septicaemia.
Methods: The etiological and antimicrobial susceptibility profile of blood cultures over a period of one year at a tertiary care hospital was studied. Blood culture positive isolates were identified by BacT/Alert3D, an automated blood culture system, while as identification of the isolates from these samples and their antimicrobial sensitivity testing was performed with Vitek2 Compact.
Results: There were 2231 blood culture samples, of which 565 (25.3%) were identified to be culture positive. Out of 565 positive cultures, 447 (79.1%) showed bacterial growth; Gram positive were 306 (54.2%) and Gram negative were 141 (24.9%). Candida species were isolated from 118 (20.9%) of positive samples. The most frequently identified Gram-positive bacteria were Coagulase-negative staphylococci 208 (67.9%) and the most common Gram-negative isolates were Acinetobacter species 89 (63.1%). The most sensitive drugs for gram-positive isolates were vancomycin, and linezolid while as gram-negative isolates showed 100% sensitivity to colistin and tigecycline.
Conclusions: This study reveals a significant prevalence of bacterial isolates in blood and it highlights the need for periodic surveillance of etiologic agent and antibiotic susceptibility to prevent further emergence and spread of resistant bacterial pathogens.
Leibovici L, Samra Z, Konigsberger H, Drucker M, Ashkenazi S, Pitlik SD. Long-term survival following bacteremia or fungemia. JAMA. 1995 Sep 13;274(10):807-12.
Berit EC, Maria PS, Jörg G, Salima M, Martin K, Oleg K. Identification and characterization of bacterial pathogens causing bloodstream infections by DNA microarray. J. Clin. Microbiol. 2006;44(7):2389-397.
Forbes BA, Sahm DF, Weissfeld AS. In: Bailey and Scott’s Diagnostic Microbiology. 12th ed. Missouri: Mosby Elsevier;2007:779.
Mehta M, Dutta P, Gupta V. Antimicrobial susceptibility pattern of blood isolates from a teaching hospital in north India. Jpn J Infect Dis. 2005;58(3):174-6.
Sader HS, Jones RN, Andrade-Baiocchi S, Biedenbach DJ; SENTRY Participants Group (Latin America). Four-year evaluation of frequency of occurrence and antimicrobial susceptibility patterns of bacteria from bloodstream infections in Latin American medical centers. Diagn Microbiol Infect Dis. 2002;44(3):273-80.
Kato-Maeda M, Bautista-Alavez A, Rolón-Montes-de-Oca AL, Ramos-Hinojosa A, Ponce-de-León A, Bobadilla-del-Valle M, et al. Increasing trend of antimicrobial drug-resistance in organisms causing bacteremia at a tertiary-care hospital: 1995 to 2000. Rev Invest Clin. 2003;55(6):600-5.
Asrat D, Amanuel Y. Prevalence and antibiotic susceptibility pattern of bacterial isolates from blood culture in Tikur Anbessa hospital, Addis Ababa. Ethiopia. Ethiop Med J. 2001;39 (Suppl 2):97-104.
James AK, Mark EJ, Deborah CD, Clyde T, Daniel FS, Gregory AV: Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002. Ann Clin Microbio Antimicrobi. 2004;3(Suppl 7):1-8.
Diekma DJ, Beekman SE, Chapin KC, Morel KA, Munson E, Deorn GV. Epidemiology and outcome of nosocomial and community onset bloodstream infection. J Clin Microbiol. 2003;41:3655-60.
Rina K, Nadeem SR, Kee PN, Parasakthi N: Etiology of blood culture isolates among patients in a multidisciplinary teaching hospital in Kuala Lumpur. J Microbiol Immunol Infect. 2007;40:432-7.
Sharma PP, Halder D, Dutta AK, Dutta R, Bhatnagar S, Bali A, et al. Bacteriological profile of neonatal septicemia. Indian Pediatr. 1987;24:1011-7.
Shanson DC. Blood culture technique: current controversies. J Antimicrob Chemother. 1990;25(Suppl C):17-29.
CLSI. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Twenty-Fourth Informational Supplement CLSI Document M100-S24, Wayne, PA.;2014.
Arora U, Devi P. Bacterial profile of blood stream infections and antibiotic resistance pattern of isolates. J K Sci. 2007;9:186-90.
Ali J, Kebede Y: Frequency of isolation and antimicrobial susceptibility pattern of bacterial isolation from blood culture in Gondar University Hospital. Ethio Med J. 2008,46(2):155-61.
Khanal B, Harish BN, Sethuraman KR, Srinivasan S. Infective endo carditis: Report of prospective study in an Indian Hospital. Trop Doct. 2002;32:83-5.
Anbumani N, Kalyani J Mallika M. Distribution and antimicrobial susceptibility of bacteria isolated from blood cultures of hospitalized patients in a tertiary care hospital. Indian J. Practising Doctor. 2008;5:5-6.
Lee A, Mirrett S, Reller LB, Weinstein MB. Detection of blood stream infections in adults: How many blood cultures are needed? J Clin Microbiol. 2007;45:3546-48.
Kaur A, Singh V. Bacterial isolates and their antibiotic sensitivity pattern in clinically suspected cases of fever of unknown origin. JK Science. 201416:105-9.
Ghiorghis B. Neonatal sepsis in Addis Ababa, Ethiopia: a review of 151 bacteremic neonates. Ethiop Med J. 1997;35(3):169-76.
Kamga HLF, Njunda Al, Nde PF, Assob JCN, Nsagha DS, Weledji P. Prevalence of Septicemia and Antibiotic Sensitivity Pattern of Bacterial isolates at the University Teaching Hospital, Yaoundé, Cameroon. Afr J Cln Exper Microbiol. 2011;12(1):2-8.
China and V. Gupta. Bacteriological profile and antimicrobial susceptibility pattern of blood isolates from a tertiary care hospital in North India. Inter J Pharm Res Biosci. 2013;2(2):24-35.
Karlowsky JA, Jones ME, Draghi DC, Thornsberry C, Sahm DF, Volturo GA. Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002. Ann Clin Microbiol Antimicro. 2004;3:7-7.
Mehdinejad M, Khosravi AD, Morvaridi A. Study of prevalence and antimicrobial susceptibility pattern of bacteria isolated from blood cultures. J Biol Sci. 2009;9(3):249-53.
Barati M, Talebi TM, Abbasi R, Mohammadzadeh M, Barati M, Shamshiri AR. Bacteriological profile and antimicrobial resistance of blood culture isolates. Iranian J Clin Infec Dis. 2009;4(2):87-95.
Ayobola ED, Egbule OS, Omonigho O. Study of prevalence and antimicrobial susceptibility of blood culture bacterial isolates. Malaysian J Microbiol. 2011 Jan 1;7(2):78-82.
Dagnew M, Yismaw G, Gizachew M, Gadisa A, Abebe T, Tadesse T, et al. Bacterial profile and antimicrobial susceptibility pattern in septicemia suspected patients attending Gondar university hospital, northwest Ethiopia. BMC Res Notes. 2013;6:283.
Boisson K, Thouverez M, Thalon D, Bertand X. Characterization of coagulase-negative staphylococci isolated from blood infections: Incidence, susceptibility to glycopeptides, and molecular epidemiology. Eur J Clin Microbiol Dis. 2002;21:660-5.
Khanna V, Mukhopadhayay C, Vandana KE, Verma M, Dabke P. Evaluation of central venous catheter associated blood stream infections: A microbiological observational study. J Patho. 2013;2013.
Alam MS, Pillai PK, Kapur P, Pillai KK. Resistant patterns of bacteria isolated from bloodstream infections at a university hospital in Delhi. J Pharm Bioallied Sci. 2011;3:525 30.
Kaistha N, Mehta M, Singla N, Garg R, Chander J. Neonatal septicemia isolates and resistance patterns in a tertiary care hospital of North India. J Infect Dev Ctries. 2009;4:55 7.
Souvenir D, Donald E, Anderson J, Palpant S, Mroch H, Askin S, et al. Blood Cultures Positive for Coagulase-Negative Staphylococci: Antisepsis, Pseudobacteremia, and Therapy of Patients. J Clin Microbiol. 1998;36(7):1923-6.
Prashanth K, Badrinath S. Nosocomial infections due to Acinetobacter species: Clinical findings, risk and prognostic factors. Indian J Med Microbiol. 2006;24:39 44.
Rungruanghiranya S, Somboonwit C, Kanchanapoom T. Acinetobacter infection in the intensive care unit. J Infect Dis Antimicrob Agents. 2005;22:77-9.
Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infection Control Hospital Epidemiol. 2008 Nov;29(11):996-1011.
Narain S. Neonatal systemic candidiasis in a tertiary care centre. Indian J Medical Microbiol. 2003;21:56 8.
Chakrabarti A, Chander J, Kasturi P, Panigrahi D, Candidaemia: a 10 -year study in an Indian teaching hospital. Mycoses. 1992;35:47-51.
Jaswinder KO, Chand W, Neeraj G, Reena R, Datta S, Kamaljeet P. Non-albicans Candida species in blood stream infections in a tertiary care hospital at New Delhi, India. Indian J Med Res. 2012;136:997-1003.
Vanitha RN, Kannan G, Venkata N,Vishwakanth D, Nagesh V, Yogitha M et al. A Retrospective study on blood stream infections and antibiotic susceptibility patterns in a tertiary care teaching hospital. Inter J Pharmacy Pharma Sci. 2012;4(1):543-48.
Wasihun AG, Wlekidan LN, Gebremariam SA, Dejene TA, Welderufael AL, Haile TD, et al. Bacteriological profile and antimicrobial susceptibility patterns of blood culture isolates among febrile patients in Mekelle Hospital, Northern Ethiopia. Springer Plus. 2015;4:314.