Prevalence, etiology, and antibiotic resistance profiles of bacterial bloodstream infections in a tertiary care hospital in Northern India: A 4-year study

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Abstract

INTRODUCTION:

Bloodstream infections (BSIs) can lead to life-threatening sepsis and are globally associated with high morbidity and mortality. Although BSIs require immediate antimicrobial treatment, their prevalence, etiology, and antimicrobial susceptibilities differ from one country to other. There is a dearth of such data from India. Here, we report the 4-year etiologic data on BSI in trauma patients admitted to a tertiary care referral hospital in New Delhi, India.

MATERIALS AND METHODS:

A retrospective study was conducted at the trauma center between January 2013 and December 2016. The routine microbiological data on bacterial BSI were recorded and determined retrospectively from the laboratory records. Antimicrobial susceptibility profiles were statistically analyzed.

RESULTS:

A total of 2017 bacterial strains isolated from blood culture samples were included for microbiological analysis. During the study, the median age of the patients varied from 30 to 35 years, with the percentage of females in the study population varying from 17% to 19%. The predominant pathogens were Gram-negative bacteria, with Acinetobacter species, followed by Klebsiella species being the most commonly isolated organisms throughout the 4 years of study. Among Gram-positive isolates, Staphylococcus species were the leading pathogens (11%–15%).

CONCLUSIONS:

A detailed analysis of prevalence, etiology of BSIs in India and its resistance profile is crucial for appropriate antibiotic use, clinical management, and formulation of antibiotic policies and preventive measures.

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Most cited references 9

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Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe.

M Goto, M.N. Al-Hasan (2013)

In this systematic review, we estimated the total number of episodes of bloodstream infection (BSI) and deaths from BSI per year in North America and Europe, using data from population-based settings. Then, we estimated the number of episodes and deaths from nosocomial BSI from population-based studies and nosocomial infection surveillance systems. We estimated 575 000-677 000 episodes of BSI per year in North America (536 000-628 000 in the USA and 40 000-49 000 in Canada) and 79 000-94 000 deaths (72 000-85 000 in the USA and 7000-9000 in Canada), using estimates from three population-based studies. We estimated over 1 200 000 episodes of BSI and 157 000 deaths per year in Europe, using estimates from one population-based study in each of the following countries: Denmark (9100 episodes and 1900 deaths), Finland (8700 episodes and 1100 deaths) and England (96 000 episodes and 12 000-19 000 deaths). There were substantial differences in estimates of nosocomial BSI between population-based and nosocomial infection surveillance data. BSI has a major impact on the morbidity and mortality of the general population, as it ranks among the top seven causes of death in all included countries in North America and Europe. However, it is difficult to obtain precise estimates of nosocomial BSI, owing to the limited number of studies. This review highlights the need for a greater focus on BSI research in order to reduce the overall burden of disease by improving the outcome of patients with BSI. It also emphasizes the role of infection control and prevention methods in reducing the burden of nosocomial BSI. ©2013 The Authors Clinical Microbiology and Infection ©2013 European Society of Clinical Microbiology and Infectious Diseases.

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Causes and Outcomes of Sepsis in Southeast Asia: A Multinational Multicentre Cross-sectional Study

Direk Limmathurotsakul (2017)

Background A better understanding of pathogens causing sepsis is important for management and antimicrobial selection. Here, we explored the causative pathogens of sepsis in Southeast Asia (SEA). Methods We prospectively recruited children (age≥30 days and <18 years) and adults (age≥18 years) at 13 public hospitals in Indonesia (n=3), Thailand (n=4) and Viet Nam (n=6). Hospitalised patients with suspected or documented community-acquired infection, with ≥3 diagnostic criteria for sepsis according to the Surviving Sepsis Campaign 2012, and within 24 hours of admission were enrolled. Blood from every patient, and nasopharyngeal swab, urine, stool and cerebrospinal fluid, if indicated, were collected for reference diagnostic tests. This study was registered with ClinicalTrials.gov, number NCT02157259. Findings From December 2013 to December 2015, 1,578 patients (763 children and 815 adults) were enrolled. Dengue viruses (n=122, 8%), Leptospira spp. (n=95, 6%), rickettsial pathogens (n=96, 6%), Escherichia coli (n=76, 5%) and influenza viruses (n=65, 4%) were commonly identified in both age groups, while Plasmodium spp. (n=12, 1%) and Salmonella enterica serovar Typhi (n=3, 0.2%) were rarely observed. Emerging pathogens identified included hantaviruses (n=28, 2%), non-typhoidal Salmonella spp (n=21, 1%), Streptococcus suis (n=18, 1%), Acinetobacter spp. (n=12, 1%), and Burkholderia pseudomallei (n=5, 0.3%). 28-day mortality was 2% in children (14/731) and 13% in adults (108/804). Severe sepsis was identified on enrolment in 27% of children (204/763) and 68% of adults (550/815), and was associated with increased mortality (adjusted odds ratio 5.3, 95% confidence interval 2.7–10.4, p<0.001). Interpretation Sepsis in SEA is caused by a wide range of known and emerging pathogens, and is associated with substantial mortality. Funding National Cancer Institute (HHSN261200800001E) and National Institute of Allergy and Infectious Diseases, National Institutes of Health, and Wellcome Trust (106680/B/14/Z and 106698/B/14/Z).

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Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome

Vu Quoc Dat, Hieu Vu, Hung Nguyen The … (2017)

Background Bloodstream infections (BSIs) are associated with high morbidity and mortality worldwide. However their aetiology, antimicrobial susceptibilities and associated outcomes differ between developed and developing countries. Systematic data from Vietnam are scarce. Here we present aetiologic data on BSI in adults admitted to a large tertiary referral hospital for infectious diseases in Hanoi, Vietnam. Methods A retrospective study was conducted at the National Hospital for Tropical Diseases between January 2011 and December 2013. Cases of BSI were determined from records in the microbiology department. Case records were obtained where possible and clinical findings, treatment and outcome were recorded. BSI were classified as community acquired if the blood sample was drawn ≤48 h after hospitalization or hospital acquired if >48 h. Results A total of 738 patients with BSI were included for microbiological analysis. The predominant pathogens were: Klebsiella pneumoniae (17.5%), Escherichia coli (17.3%), Staphylococcus aureus (14.9%), Stenotrophomonas maltophilia (9.6%) and Streptococcus suis (7.6%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 25.1% (67/267 isolates) and of methicillin-resistance in S. aureus (MRSA) 37% (40/108). Clinical data was retrieved for 477 (64.6%) patients; median age was 48 years (IQR 36–60) with 27.7% female. The overall case fatality rate was 28.9% and the highest case fatality was associated with Enterobacteriaceae BSI (34.7%) which accounted for 61.6% of all BSI fatalities. Conclusions Enterobacteriaceae (predominantly K. pneumoniae and E. coli) are the most common cause of both community and hospital acquired bloodstream infections in a tertiary referral clinic in northern Vietnam.

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Author and article information

Journal

Journal ID (nlm-ta): J Lab Physicians

Journal ID (iso-abbrev): J Lab Physicians

Journal ID (publisher-id): JLP

Title: Journal of Laboratory Physicians

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0974-2727

ISSN (Electronic): 0974-7826

Publication date (Print): Oct-Dec 2018

Volume: 10

Issue: 4

Pages: 426-431

Affiliations

[1] Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

[1 ] Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

[2 ] Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India

Author notes

Address for correspondence: Dr. Purva Mathur, Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail: purvamathur@ 123456yahoo.co.in

Article

Publisher ID: JLP-10-426

DOI: 10.4103/JLP.JLP_78_18

PMC ID: 6210839

PubMed ID: 30498316

SO-VID: f71b1ac4-4526-4be1-ab25-2e800242a9dc

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This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Prevalence, etiology, and antibiotic resistance profiles of bacterial bloodstream infections in a tertiary care hospital in Northern India: A 4-year study

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Abstract

INTRODUCTION:

MATERIALS AND METHODS:

RESULTS:

CONCLUSIONS:

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Journal of Circulating Biomarkers

Most cited references 9

Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe.

Causes and Outcomes of Sepsis in Southeast Asia: A Multinational Multicentre Cross-sectional Study

Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome

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