Detection of ESBL Producing Escherichia coli isolates from blood cultures and its effect on outcome of Sepsis Patients at a rural based tertiary care and teaching hospital in Vadodara district, Gujarat

Background: Sepsis is one of the most common clinical conditions that cause substantial morbidity and mortality all over the world. Blood culture is considered to be the gold standard for the identification of bacteria as a cause of sepsis along with the pattern of antibiotic susceptibility that helps clinicians to choose the appropriate empirical antibiotic. E. coli, belonging to the family Enterobacteriaceae, is a very important pathogen causing infections in humans. It causes a number of important clinical conditions like urinary tract infections, diarrhea, peritonitis, visceral abscesses, endovascular infections, septicemia pneumonia, meningitis, osteomyelitis, wound and soft tissue infections. Due to increased resistance to drugs and ability to produce variety of beta-lactamase enzymes (extended-beta lactamases) poses a difficulty in treating infections caused due to E. coli. Objectives: Objectives of this study were (a) to detect ESBL production amongst the E.coli isolated from the blood cultures of patients with sepsis and (b) to determine its effect on the outcome of sepsis patients from a rural based tertiary hospital in Vadodara district of Gujarat. Rana-Khara R, Lakhani SJ, Vasava S, Panjwani D. Detection of ESBL Producing Escherichia coli isolates from blood cultures and its effect on outcome of Sepsis Patients at a rural based tertiary care and teaching hospital in Vadodara district, Gujarat. IAIM, 2017; 4(5): 111-116. Page 112 Materials and methods: A total of 48 E. coli isolates were obtained from the blood culture of 46 patients with clinically diagnosed sepsis. These 48 E. coli isolates were tested for detection of ESBL production according to the CLSI guidelines using phenotypic screening & confirmatory methods. Results: From a total of 48 E. coli isolates obtained from blood culture of 46 clinically diagnosed sepsis, 24 were female patients (as 2 patients had 2 blood samples cultured) and 22 were males. Of the total 48 E. coli isolates tested for ESBL production, 23 (47.91%) isolates from 23 (50%) patients were found to be producing ESBL and 25 (52.08%) isolates from other 23 (50%) patients did not produce ESBL. Of the 23 patients with ESBL producing E. coli, 14 (60.86%) patients did not survive the episode of sepsis, whereas 7 (30.43%) survived and for 2 (8.69%) patients the outcome was not known as they took discharge against the medical advice. Amongst the 23 patients with 25 blood samples yielding non-ESBL producing E. coli, 8 (34.78%) did not survive, 14 (60.86%) survived and for 1(4.34%) patient the outcome was not known. Thus the mortality was more in patients with sepsis due to ESBL producing E. coli as compared to patients with non-ESBL producing E.coli. Also the urinary tract/kidneys were the common source of infection and kidneys were the organ affected. The ESBL producing E. coli showed a higher resistance to most of the antibiotics used but a higher susceptibility to Imipenem and Ertapenem. Conclusion: The findings of our study suggests a higher prevalence of ESBL producing E. coli, which exhibit a higher resistance to most of the antibiotics, are associated with greater mortality and pose a real challenge in the management of patients with sepsis.

Isolation, Identification and Antifungal Susceptibility Testing of Candida species from Sepsis Patients from a rural based tertiary care and teaching hospital in Vadodara district, Gujarat

Background: Sepsis is a global problem causing substantial morbidity and mortality to the patients afflicted with it. Moreover sepsis due to fungal infections, especially, the Candida infections has increased in the recent times due to increase in patients with immunocompromised conditions. They are the normal commensal of the oral cavity, GIT and the mucosal surfaces in the body as well as the pathogens leading to colonization and also infection. Though Candida albicans is the most commonly isolated fungal pathogen from clinical samples, gradually non-albicans Candida species are becoming predominant pathogens. The increased use of anti-fungal agents for treatment and also for prophylaxis especially in ICU patients has lead to development of resistance against commonly used anti-fungal agents in the treatment like various azoles. Thus this study was carried out to identify different Candida species from specimens of clinically diagnosed sepsis patients and their antifungal susceptibility pattern which can be utilized for better management of sepsis patients. Objectives: The objectives of this study were to isolate and identify the species of Candida from different samples of clinically diagnosed sepsis patients and to determine the susceptibility pattern of the Candida species isolates against the commonly used anti-fungal agents from the clinical samples of sepsis patients from a rural based tertiary care and teaching hospital. Khara R, Lakhani SJ, Vasava S. Isolation, Identification and Antifungal Susceptibility Testing of Candida species from Sepsis Patients from a rural based tertiary care and teaching hospital in Vadodara district, Gujarat. IAIM, 2017; 4(7): 151- 160. Page 152 Materials and methods: A total of 100 Candida species were isolated from different samples of clinically diagnosed sepsis patients. These were identified on the basis of gram stain of the samples, colony morphology on Saboraud’s Dextrose agar and HiCrome also germ tube and chlamydospore formation. The antifungal susceptibility testing was done according to CLSI M44-A2 for yeasts. Results: A total of 100 (14.26%) Candida species were isolated out of the total 701 isolates from 1136 different samples cultured from clinically diagnosed sepsis patients. Of these, 53% were C. albicans, 37% C. non-albicans, 6% C. glabrata and 4% C. tropicalis. Also 35% were obtained from blood, 20% from catheterized urine, 19% from sputum, 14% from non-catheterized urine, 7% from ET (Endotracheal) tips/secretions and the smaller percentage from other specimens. The antifungal testing showed a higher resistance to most of the antifungal agents tested with 80% towards clotrimazole, 77% to ketoconazole and 63% to fluconazole and 62% towards itraconazole. However, 80% of Candida species were susceptible to amphotericin B followed by 33% to fluconazole and 80% were susceptible-dose-dependent to nystatin. Conclusion: The findings of our study suggest that Candida species are an important pathogen causing various infections in our patients leading to sepsis as well as a higher resistance to most of the antifungal agents tested poses a real challenge in the management of patients with sepsis due to Candida. Thus routine identification using HiCrome Media and antifungal susceptibility testing by disc diffusion method for yeasts will help in better management of sepsis due to Candida infections.