RESUMEN
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