ABSTRACT
Objective: To determine the frequency of pathogens causing bloodstream infections and evaluate their trends and antibiogram patterns among in-patients in a paediatric tertiary care centre
Study Design: Descriptive study
Place and Duration of Study: French Medical Institute for Mothers and Children [FMIC], Kabul, Afghanistan in two phases, from January 2010 to December 2015
Methodology: Results of blood cultures from suspected cases of sepsis admitted in the FMIC, from January 2010 to December 2012 [Period-1], and from January 2013 to December 2015 [Period-2] were completed. Standard microbiological methods were followed for blood culture and antibiotic sensitivity testing
Results: Out of total 1,040 cases of culture proven sepsis, 528 [50.77%] Gram-negative bacilli [GNB], 474 [45.58%] Gram-positive cocci [GPC], and 38 [3.65%] Candida species were isolated during the entire study period. Out of 528 GNB isolates, 373 [70.64%] belonged to the Enterobacteriaceae and 155 [29.36%] were non-fermenters. Among Enterobacteriaceae, 168 [31.82%] were Klebsiella species [K. pneumoniae=124, K. oxytoca=44], 70 [13.26%] were Enterobacter species [E. cloacae=52, E. aerogenes=18], 65 [12.31%] were E. coli, 37 [7.01%] were Serratia marcescens and 31 [5.87%] were others. Out of 155 non-fermenters, 88 [16.67%] were Pseudomonas aeruginosa, 39 [7.39%] were Burkholderia cepacia and 18 [3.41%] were Stenotrophomonas maltophilia. There was a drop in the frequency of Enterobacteriaceae from 85% in Period-1 to 58.68% in Period-2. There was an increase in the frequency of nonfermenters from 15% to 41.32%, particularly 18 new cases of sepsis caused by Stenotrophomonas maltophilia during Period-2. Among GPC, there was an overall rise of 16.14% in the prevalence of Staphylococcus epidermidis during Period-2 and a drop of 9.64% in the frequency of Staphylococcus aureus during Period-2. The majority of Gram-negative isolates were multidrug-resistant to commonly used antibiotics. However, most of the isolates were sensitive to amikacin and imipenem [except S. maltophilia]. The frequency of those producing ESBL reduced by 11.22% during the Period-2. Among Gram-positive cocci, the pattern of antibiogram did not show a significant change during both periods, and majority remained resistant to commonly used antibiotics. All Staphylococci were sensitive to vancomycin but resistant to penicillin. There was a substantial decline of 18.87% in the frequency of Methicillin-resistant Staphylococci [MRSA/MRSE] during Period-2
Conclusion: Staphylococci and Klebsiellae remain the most important bacteria responsible for bloodstream infections in a tertiary healthcare facility in Kabul. Yet, there has been an increase in the prevalence of Pseudomonas and Burkholderia cepacia. Moreover, Stenotrophomonas maltophilia emerged as a new hospital acquired pathogen. This study could possibly help in suggesting choices eluding the misuse of appropriate antibiotics
ABSTRACT
The aim of this study was to determine the occurrence of extended spectrum beta-lactamase [ESBL]-producing species of Enterobacteriaceae to control their spread, from March 2008 to June 2012. A total of 411 ESBL-producing isolates were reported belonging to the family Enterobacteriaceae. There were 235 [57.18%] hospital-acquired infections [HAIs] and 176 [42.82%] community-acquired infections [CAIs]. Out of total isolates, majority were E. coli [n=165, 40.15%], followed by 38.93% Klebsiella spp. [n=161], 9.97% Enterobacter spp. [n=41] and 6.33% Serratia spp. [n=26]. Amongst HAIs, most frequent i.e., 111/235 [47.23%] were Klebsiella spp, whereas, amongst CAIs, majority i.e., 96/176 [54.55%] were E. coli. The frequency of ESBL-producing isolates from different sites was blood [37.71%], urine [29.93%], respiratory tract [18.49%] and other sites including pus/pus swabs, CSF/body fluids and secretions [13.87%] respectively. Majority of blood stream infections were caused by ESBL-producing Klebsiella species which accounted for 55.48% of all cases who had septicaemia, whereas E. coli was responsible for causing majority of urinary tract infections [UTIs] and accounted for 78% of all UTIs cases. Intensive Care Unit [ICU] was the place where majority of infections [55%] were observed, followed by 29% in the Medical Unit and 16% in the Surgical Unit