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CC BY-NC-ND 4.0 · J Lab Physicians 2020; 12(01): 56-67
DOI: 10.1055/s-0040-1714199
Original Article

Ecology of Bloodstream Infections and Temporal Trends of Their Antibiograms with Respect to Source and Duration of Incubation: A 5-Year Retrospective Observational Analysis

Amit Banik 
1   All India Institute of Hygiene & Public Health, Kolkata, West Bengal, India
,
Valarie W. Lyngdoh
2   Department of Microbiology, NEIGRIHMS, Shillong, Meghalaya
,
Elantamilan Durairaj
2   Department of Microbiology, NEIGRIHMS, Shillong, Meghalaya
,
Anil C. Phukan
2   Department of Microbiology, NEIGRIHMS, Shillong, Meghalaya
,
Raghavendra Kotal
3   Department of Anaesthesiology & Critical Care, NEIGRIHMS, Shillong, Meghalaya
› Author Affiliations Financial Support None.
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Abstract

Purpose Blood is one of the most important connective tissues of human body. Bloodstream infection can range from inapparent bacteremia till fulminant septic shock with high mortality. Presence of microbes in blood whether continuously, intermittently, or transiently is a grave risk to every organ of body. Culture of blood is a vital tool to diagnose such infections. Drug susceptibility patterns help in rationalizing therapy.

Objective The aim of the study is to perform bacteriological analysis and assess drug sensitivity patterns of blood culture isolates and compare in light of other associated variables.

Design Retrospective observational study was conducted from January 2009 to December 2013 at a tertiary care hospital at Shillong, India. Blood samples were collected with aseptic guidelines and cultured for 7 days. Growths were identified by standard biochemical tests and subjected to sensitivity testing according to Modified Kirby Bauer disk diffusion method. Data for source of blood collection and duration of incubation were noted and compared.

Results A total of 658 (11.2%) pathogens were isolated from 5,867 bacteremia-suspected patient blood specimens. Contamination was observed at the rate of 1.21%. Gram-negative organisms were the predominant pathogens recovered, Klebsiella pneumoniae being the most common. No significant difference was observed between the number of organisms isolated within or beyond 48 hours. Acinetobacter baumannii and K. pneumoniae have significantly higher chances (p < 0.05) of isolation from central line catheters compared with peripheral venipuncture.

Conclusion Successful treatment of sepsis depends on early diagnosis and proper antimicrobial therapy. Local knowledge of bacteriological profile and antimicrobial sensitivity patterns helps rationalize empiric treatment strategies.

Keywords

bloodstream infection - Meghalaya - antimicrobial sensitivity - blood culture - empirical therapy

Supplementary Material



Publication History

Article published online:
11 August 2020

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Thieme Medical and Scientific Publishers Private Ltd.
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  • References

  • 1 Seifert H, Wisplinghoff H. Bloodstream infection and endocarditis. In: Borriello SP, Murray PR, Funke G. eds. Topley and Wilson’s Microbiology and Microbial Infections, Bacteriology. Vol 1. 10th ed. London: Hodder Arnold ASM Press; 2005: 1181-1235
    Google Scholar
  • 2 Munford RS, Suffredini AF. Sepsis, severe sepsis and septic shock. In: Bennett JE, Dolin R, Blaser MJ. eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. Vol 1. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015: 914-934
    Google Scholar
  • 3 Vasudeva N, Nirwan PS, Shrivastava P. Bloodstream infections and antimicrobial sensitivity patterns in a tertiary care hospital of India. Ther Adv Infect Dis 2016; 3 (05) 119-127
    PubMedGoogle Scholar
  • 4 Weinstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis 1996; 23 (01) 40-46
    CrossrefPubMedGoogle Scholar
  • 5 CLSI. Principles and Procedures for Blood Cultures; Approved Guideline. CLSI Document M47-A. Wayne, PA: Clinical and Laboratory Standards Institute; 2007
    Google Scholar
  • 6 Performance standards for Antimicrobial Susceptibility Testing. Twenty-Fourth Informational Supplement. CLSI Document M100–S24. Wayne, PA: Clinical and Laboratory Standards Institute; 2014
    Google Scholar
  • 7 Hall KK, Lyman JA. Updated review of blood culture contamination. Clin Microbiol Rev 2006; 19 (04) 788-802
    CrossrefPubMedGoogle Scholar
  • 8 Weinstein MP, Reller LB, Murphy JR, Lichtenstein KA. The clinical significance of positive blood cultures: a comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis 1983; 5 (01) 35-53
    CrossrefPubMedGoogle Scholar
  • 9 Weinstein MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol 2003; 41 (06) 2275-2278
    CrossrefPubMedGoogle Scholar
  • 10 Prabhu K, Bhat S, Rao S. Bacteriologic profile and antibiogram of blood culture isolates in a pediatric care unit. J Lab Physicians 2010; 2 (02) 85-88
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999; 115 (02) 462-474
    CrossrefPubMedGoogle Scholar
  • 12 Leibovici L, Paul M, Poznanski O. et al. Monotherapy versus beta-lactam-aminoglycoside combination treatment for gram-negative bacteremia: a prospective, observational study. Antimicrob Agents Chemother 1997; 41 (05) 1127-1133
    CrossrefPubMedGoogle Scholar
  • 13 Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244 (05) 379-386
    CrossrefPubMedGoogle Scholar
  • 14 Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118 (01) 146-155
    CrossrefPubMedGoogle Scholar
  • 15 Kumar A, Roberts D, Wood KE. et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34 (06) 1589-1596
    CrossrefPubMedGoogle Scholar
  • 16 Jagdish L, Naik TB, Gupta RK, Jais M. Etiology of blood culture from septicemia cases and their antibiotic susceptibility pattern at a tertiary care hospital. Indian J Microbiol Res 2016; 3: 436-440
    Google Scholar
  • 17 Wattal C, Raveendran R, Goel N, Oberoi JK, Rao BK. Ecology of blood stream infection and antibiotic resistance in intensive care unit at a tertiary care hospital in North India. Braz J Infect Dis 2014; 18 (03) 245-251
    CrossrefPubMedGoogle Scholar
  • 18 Rajeevan S, Ahmed SM, Jasmin PT. Study of prevalence and antimicrobial susceptibility pattern in blood isolates from a tertiary care hospital in North Kerala, India. Int J Curr Microbiol Appl Sci 2014; 3: 655-662
    Google Scholar
  • 19 Sharma R, Sharma R, Gupta S. Bacteriological analysis of blood culture isolates with their antibiogram from a tertiary care hospital. Int J Pharm Sci Res 2015; 6: 4847-4851
    Google Scholar
  • 20 Gupta S, Kashyap B. Bacteriological profile and antibiogram of blood culture isolates from a tertiary care hospital of North India. Trop J Med Res 2016; 19: 94-99
    CrossrefGoogle Scholar
  • 21 Roy I, Jain A, Kumar M, Agarwal SK. Bacteriology of neonatal septicaemia in a tertiary care hospital of northern India. Indian J Med Microbiol 2002; 20 (03) 156-159
    CrossrefPubMedGoogle Scholar
  • 22 Gohel K, Jojera A, Soni S, Gang S, Sabnis R, Desai M. Bacteriological profile and drug resistance patterns of blood culture isolates in a tertiary care nephrourology teaching institute. BioMed Res Int 2014; 2014: 153747
    CrossrefPubMedGoogle Scholar
  • 23 Tariq TM. Bacteriologic profile and antibiogram of blood culture isolates from a children’s hospital in Kabul. J Coll Physicians Surg Pak 2014; 24 (06) 396-399
    PubMedGoogle Scholar
  • 24 Quereshi M, Aziz F. Prevalence of microbial isolates in blood cultures and their antimicrobial susceptibility profiles. Biomedica 2011; 27: 136-139
    Google Scholar
  • 25 Meremikwu MM, Nwachukwu CE, Asuquo AE, Okebe JU, Utsalo SJ. Bacterial isolates from blood cultures of children with suspected septicaemia in Calabar, Nigeria. BMC Infect Dis 2005; 5: 110
    CrossrefPubMedGoogle Scholar
  • 26 Archibald LK, Pallangyo K, Kazembe P, Reller LB. Blood culture contamination in Tanzania, Malawi, and the United States: a microbiological tale of three cities. J Clin Microbiol 2006; 44 (12) 4425-4429
    CrossrefPubMedGoogle Scholar
  • 27 Diekema DJ, Beekmann SE, Chapin KC, Morel KA, Munson E, Doern GV. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J Clin Microbiol 2003; 41 (08) 3655-3660
    CrossrefPubMedGoogle Scholar
  • 28 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 Antimicrob 2004; 3: 7
    CrossrefPubMedGoogle Scholar
  • 29 Bryan CS. Clinical implications of positive blood cultures. Clin Microbiol Rev 1989; 2 (04) 329-353
    CrossrefPubMedGoogle Scholar
  • 30 Beutz M, Sherman G, Mayfield J, Fraser VJ, Kollef MH. Clinical utility of blood cultures drawn from central vein catheters and peripheral venipuncture in critically ill medical patients. Chest 2003; 123 (03) 854-861
    CrossrefPubMedGoogle Scholar