scholarly journals Multi-drug resistance and high mortality associated with community-acquired bloodstream infections in children in conflict-affected northwest Nigeria

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Frederick Chukwumeze ◽  
Annick Lenglet ◽  
Ruth Olubiyo ◽  
Abdulhakeem Mohammed Lawal ◽  
Bukola Oluyide ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Blood Culture ◽  
Point Of Care ◽  
Bloodstream Infections ◽  
Clinical Severity ◽  
Multi Drug Resistance ◽  
Bacterial Isolates ◽  
Extended Spectrum Beta Lactamase ◽  
Sub Saharan ◽  
Secondary Hospital

AbstractPediatric community-acquired bloodstream infections (CA-BSIs) in sub Saharan African humanitarian contexts are rarely documented. Effective treatment of these infections is additionally complicated by increasing rates of antimicrobial resistance. We describe the findings from epidemiological and microbiological surveillance implemented in pediatric patients with suspected CA-BSIs presenting for care at a secondary hospital in the conflict affected area of Zamfara state, Nigeria. Any child (> 2 months of age) presenting to Anka General Hospital from November 2018 to August 2020 with clinical severe sepsis at admission had clinical and epidemiological information and a blood culture collected at admission. Bacterial isolates were tested for antibiotic susceptibility. We calculated frequencies of epidemiological, microbiological and clinical parameters. We explored risk factors for death amongst severe sepsis cases using univariable and multivariable Poisson regression, adjusting for time between admission and hospital exit. We included 234 severe sepsis patients with 195 blood culture results. There were 39 positive blood cultures. Of the bacterial isolates, 14 were Gram positive and 18 were Gram negative; 5 were resistant to empiric antibiotics: methicillin-resistant Staphylococcus aureus (MRSA; n = 2) and Extended Spectrum Beta-Lactamase positive enterobacterales (n = 3). We identified no significant association between sex, age-group, ward, CA-BSI, appropriate intravenous antibiotic, malaria positivity at admission, suspected focus of sepsis, clinical severity and death in the multivariable regression. There is an urgent need for access to good clinical microbiological services, including point of care methods, and awareness and practice around rational antibiotic in healthcare staff in humanitarian settings to reduce morbidity and mortality from sepsis in children.

scholarly journals Current Trends of Gram-negative Bacteremia in a State of North India, the Forthcoming Challenges IGMC Shimla

2021 ◽  
pp. 21-27
Author(s):  
Pankaj Katoch ◽  
Anil Kanga
Keyword(s):  
Blood Culture ◽  
Critical Role ◽  
Tertiary Care ◽  
Age Groups ◽  
Bloodstream Infections ◽  
North India ◽  
Gram Negative Bacteria ◽  
Bacterial Isolates ◽  
Gram Negative ◽  
Gram Negative Bacteremia

Background: Vascular endothelial dysfunction plays a critical role in the evolution of sepsis there is an increase in vascular permeability leading to coagulation abnormalities and subsequent dysfunction of major organs.1 Bloodstream infections are a cause of life-threatening complications in all age groups of the population especially the extreme age groups who are very much prone to the risk. Antibiotic usage is associated with bacteremia, septicemia, and mortality through many factors. We are aware that Gram-negative bacteria due to many causes are becoming increasingly resistant to the currently used antimicrobial therapy. Here, in this study, we report the incidence and etiology and of the Gram-Negative bacterial isolates and their clinical significance from our tertiary care institute located in the Northern part of India. Materials and Methods: Prospective Observational Study conducted in the Department of Microbiology IGMC Shimla for a tenure of one year to determine the incidence and etiology of Gram-negative bacterial isolates and their antimicrobial resistance profile. All the blood culture samples received in the Department of Microbiology IGMC Shimla for culture by Bactec Bd fx from July 2015 to June 2016 were included in the study except for falling in the exclusion criteria. The blood culture was observed in the Bactec bd fx system for at least 5 days before they are reported as sterile. Results: Among the total 1275 cultures which were positive for bacteria, 931(73.02%) were positive for Gram-negative bacteria. Among the total of 931culture that were positive for Gram-negative bacteria, The Non-fermenter group of organisms was isolated in 292(31.36%) cultures, followed by E. coli 266(28.57%). Among the total of 931 cultures positive for GNB, a maximum of 335 (35.98%) belonged to 0-1 year. Among them, 574 (61.65%) were males while 357 (38.35%) were females. Conclusion: Nonfermenter group was the commonest organism among Gram-negative isolates. Infants were more commonly positive as compared to another age group. Males were more commonly culture positive as compared to females among gram-negative isolates.

scholarly journals Bacterial profile and multi-drug resistance pattern of bacterial isolates among septicemia suspected cases: a meta-analysis report in Ethiopia

2021 ◽  
Vol 45 (3) ◽  
pp. 167-178
Author(s):  
Mengistu Abayneh ◽  
Shewangizaw HaileMariam ◽  
Molla Asnake
Keyword(s):  
Drug Resistance ◽  
Blood Culture ◽  
Meta Analysis ◽  
Multi Drug Resistance ◽  
Resistance Pattern ◽  
Bacterial Isolates ◽  
Gram Positive ◽  
Gram Negative ◽  
Drug Resistance Pattern ◽  
Culture Positive

Abstract Background Bloodstream infections (BSIs) are one of the most common infections seen in all age groups and in all locations. The current knowledge on the patterns of bacterial profile, and its antibiotic resistance are essential to design and implement appropriate interventions. This study was conducted to assess the prevalence and multi-drug resistance pattern of bacterial isolates among septicemia and/or bacteremia suspected cases in Ethiopia. Methods Searching was conducted in databases of PubMed, Research Gate, Scopus and Google Scholar. In addition, manual searching is also conducted in bibliographies of included studies and in other meta-analysis studies. Required data were extracted from articles published up to 2020 on the bacterial profile of septicemia in Ethiopia, and analyzed using comprehensive meta-analysis version 3.3.0 software. Results A total of 5,823 septicemia suspected cases were extracted from 18 included studies and the overall blood culture positive rate of 31.9% (95% CI: 0.261–0.382). Of these, the overall Gram positive and Gram negative isolates was 57.8% (95% CI: 0.534–0.584) and 42.2% (95% CI: 0.416–0.466), respectively. Among Gram positives, predominantly reported isolates was Staphylococcus  aureus (47.9%: 480 of 1,003), followed by Coagulase-Negative Staphylococcus (42.7%: 428 of 1,003), whereas among Gram negatives, the most frequently reported isolates was Klebsiella species (29.8%: 218 of 731), followed by Escherichia  coli (23.1%: 169 of 731). Significant levels of resistance was reported against ampicillin, amoxicillin, ceftriaxone, co-trimoxazole and tetracycline with a pooled resistance range of 40.6–55.3% in Gram positive and 52.8–85.7% in Gram negative isolates. The pooled estimates of multi-drugs resistance (MDR) was (66.8%) among Gram positives and (80.5%) among Gram negatives, with the overall MDR rate of (74.2%). Conclusions The reported blood culture positive rates among septicemia cases were relatively high. Second, the level of drug and multi-drug resistant isolates against commonly prescribed antibiotics was significant. However, the scarcity of data on culture confirmed septicemia cases as well as patterns of antimicrobial resistance may overshadow the problem.

scholarly journals Sensitive Detection of Francisella tularensis Directly from Whole Blood by Use of the GeneXpert System

2016 ◽  
Vol 55 (1) ◽  
pp. 291-301 ◽  
Author(s):  
Padmapriya P. Banada ◽  
Srinidhi Deshpande ◽  
Soumitesh Chakravorty ◽  
Riccardo Russo ◽  
James Occi ◽  
...  
Keyword(s):  
Blood Culture ◽  
Francisella Tularensis ◽  
Whole Blood ◽  
Dynamic Range ◽  
Limit Of Detection ◽  
Point Of Care ◽  
Bloodstream Infections ◽  
Content Type ◽  
Testing Procedures ◽  
Point Of Care Detection

ABSTRACTFrancisella tularensisis a potential bioterrorism agent that is highly infectious at very low doses. Diagnosis of tularemia by blood culture and nucleic acid-based diagnostic tests is insufficiently sensitive. Here, we demonstrate a highly sensitiveF. tularensisassay that incorporates sample processing and detection into a single cartridge suitable for point-of-care detection. The assay limit of detection (LOD) and dynamic range were determined in a filter-based cartridge run on the GeneXpert system.F. tularensisDNA in buffer or CFU ofF. tularensiswas spiked into human or macaque blood. To simulate detection in human disease, the assay was tested on blood drawn from macaques infected withF. tularensisSchu S4 at daily intervals. Assay detection was compared to that with a conventional quantitative PCR (qPCR) assay and blood culture. The assay LOD was 0.1 genome equivalents (GE) per reaction and 10 CFU/mlF. tularensisin both human and macaque blood. In infected macaques, the assay detectedF. tularensison days 1 to 4 postinfection in 21%, 17%, 60%, and 83% of macaques, respectively, compared to conventional qPCR positivity rates of 0%, 0%, 30%, and 100% and CFU detection of blood culture at 0%, 0%, 0%, and 10% positive, respectively. Assay specificity was 100%. The new cartridge-based assay can rapidly detectF. tularensisin bloodstream infections directly in whole blood at the early stages of infection with a sensitivity that is superior to that of other methods. The simplicity of the automated testing procedures may make this test suitable for rapid point-of-care detection.

scholarly journals 115. Influence of Antimicrobial Stewardship and Molecular Rapid Diagnostic Test on Antimicrobial Prescribing for Extended-spectrum Beta-lactamase and Carbapenemase-producing Bacteria in Bloodstream Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S71-S72
Author(s):  
Ashlan Kunz Coyne ◽  
Anthony Casapao ◽  
Carmen Isache ◽  
James Morales ◽  
Yvette McCarter ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Bloodstream Infections ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
Kaplan Meier ◽  
Baseline Characteristics

Abstract Background Molecular rapid diagnostic tests (mRDT) may help expedite the time to optimal antimicrobial therapy (TTOT) for extended-spectrum beta-lactamase (ESBL)- and carbapenemase-producing bacteria in bloodstream infections (BSI). The greatest impact of mRDT appears to occur when combined with antimicrobial stewardship program (ASP) intervention. The purpose of this study was to evaluate if mRDT + ASP influences the TTOT for patients with ESBL- and carbapenemase-producing E. coli and K. pneumoniae in BSI compared to conventional microbiological methods with ASP (CONV + ASP). Methods Multicenter, retrospective, cohort study evaluating five years of patients that had a positive E. coli or K. pneumoniae blood culture determined to be ESBL- or carbapenemase-producing by mRDT and/or CONV. Patients were excluded if they had polymicrobial BSI, transferred–in with previously identified positive blood cultures, were immunosuppressed, or died before culture results. Primary outcome was TTOT defined as time from blood culture draw to start of carbapenem therapy for ESBL-producing BSI and ceftazidime-avibactam, meropenem-vaborbactam, or at least one drug active in-vitro with the most-narrow spectrum for carbapenemase-producing BSI. Secondary outcomes were time to microbial clearance (TTMC) defined as the time from index blood culture draw to the time of first negative blood culture or hospital discharge, all-cause hospital mortality, 30-, 60- and 90-day readmission rates, and Clostridioides difficile rates. Results A total of 378 patients were included for analysis. Baseline characteristics were balanced between mRDT + ASP (n=164) and CONV + ASP (n=214). Infectious diseases consults were significantly greater for CONV + ASP compared to mRDT + ASP (82.2% vs 34.8%; p< 0.001). The mRDT + ASP demonstrated a statistically significant decrease in TTOT (20.5 hrs [(IQR 17.0–42.2 hrs)] vs 50.1 hrs [(IQR 27.6–77.9 hrs)]; p< 0.001) and TTMC (71.9 hrs [(IQR 54.1–108.5 hrs)] vs 91.2 hrs [(IQR 64.6–134.3 hrs)]; p=0.007). Other secondary endpoints were similar between groups. Table 1. Comparison of baseline characteristics for the mRDT+ASP and CONV+ASP groups Graph 1. Kaplan Meier time to optimal antimicrobial therapy Graph 2. Kaplan Meier time to microbial clearance Conclusion Our study supports the additional benefit of mRDT to ASP on shortening the TTOT and TTMC in patients with ESBL- or carbapenemase-producing E. coli and K. pneumoniae in BSI compared to CONV + ASP. Disclosures All Authors: No reported disclosures

scholarly journals Study of prevalence and antimicrobial susceptibility pattern of blood culture isolates from a tertiary care hospital of North India

2018 ◽  
Vol 6 (12) ◽  
pp. 4046 ◽  
Author(s):  
Asifa Nazir ◽  
Ifshana Sana ◽  
Bushra Yousuf Peerzada ◽  
Tabindah Farooq
Keyword(s):  
Blood Culture ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Care Hospital ◽  
Bacterial Isolates ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Positive

Background: Bacterial bloodstream infections (BSIs) are important causes of morbidity and mortality world-wide. The choice of antimicrobial therapy for bloodstream infections is often empirical and based on the knowledge of local antimicrobial activity profiles of the most common bacteria causing such infections. The objective of the study was to determine the pattern of bacterial isolates from the blood cultures in a teaching hospital and determine their antibiotic resistance and provide guidelines for choosing an effective antibiotic therapy in cases of septicaemia.Methods: The etiological and antimicrobial susceptibility profile of blood cultures over a period of one year at a tertiary care hospital was studied. Blood culture positive isolates were identified by BacT/Alert3D, an automated blood culture system, while as identification of the isolates from these samples and their antimicrobial sensitivity testing was performed with Vitek2 Compact.Results: There were 2231 blood culture samples, of which 565 (25.3%) were identified to be culture positive. Out of 565 positive cultures, 447 (79.1%) showed bacterial growth; Gram positive were 306 (54.2%) and Gram negative were 141 (24.9%). Candida species were isolated from 118 (20.9%) of positive samples. The most frequently identified Gram-positive bacteria were Coagulase-negative staphylococci 208 (67.9%) and the most common Gram-negative isolates were Acinetobacter species 89 (63.1%). The most sensitive drugs for gram-positive isolates were vancomycin, and linezolid while as gram-negative isolates showed 100% sensitivity to colistin and tigecycline.Conclusions: This study reveals a significant prevalence of bacterial isolates in blood and it highlights the need for periodic surveillance of etiologic agent and antibiotic susceptibility to prevent further emergence and spread of resistant bacterial pathogens.

Bloodstream infections and antibiotic sensitivity pattern in intensive care unit

2020 ◽  
pp. 004947552097704
Author(s):  
Parul Chaturvedi ◽  
Mamta Lamba ◽  
Deepak Sharma ◽  
Ved P Mamoria
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Microbial Growth ◽  
Antibiotic Sensitivity ◽  
Bloodstream Infections ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Sensitivity Pattern ◽  
Esbl Producers

Bloodstream infection remains one of the most important causes of morbidity and mortality globally, specifically among intensive care unit patients. This prospective observational study included 887 blood culture samples collected cases admitted to intensive care unit suspected of having sepsis. Samples were cultured and evaluated for antimicrobial susceptibility patterns: 202 (22.78%) blood cultures were positive and yielded microbial growth with 132 (14.88%) having mono-microbial growth. Gram-negative bacteria accounted for 45.2% cases, with Escherichia coli being the most common; Gram positives accounted for 43.9% with Staphylococci haemolyticus being most common and 10.9% were fungal isolates. Gram-negative isolates were sensitive to colistin and tigecycline and 77.3% of isolates were extended spectrum beta-lactamase (ESBL) producers. Gram-positive isolates were sensitive to tigecycline, linezolid, vancomycin and teicoplanin with 97.5% being methicillin-resistant Staphylococci (MRSA). Most of the blood culture isolates from critically ill patients in intensive care unit were multidrug-resistant, ESBL producers and MRSA which raises a serious concern about the development of serious antibiotic resistance.

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

scholarly journals 270. Clinical Outcomes of Ceftriaxone versus Penicillin G for Complicated Viridans Group Streptococci Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Stephanie Wo ◽  
Yanina Dubrovskaya ◽  
Justin Siegfried ◽  
John Papadopoulos ◽  
Shin-Pung Jen
Keyword(s):  
Clinical Outcomes ◽  
Hospital Readmission ◽  
Protective Factor ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Penicillin G ◽  
Eligibility Criteria ◽  
Extended Spectrum Beta Lactamase ◽  
Increased Risk ◽  
Viridans Group Streptococci

Abstract Background Viridans group streptococci (VGS) is an infrequent yet significant cause of bloodstream infections, and complicated cases may require prolonged antibiotic therapy. Ceftriaxone (CTX) and penicillin G (PCN G) are both considered first line options for VGS infections, but comparisons between these agents are limited. We evaluated the clinical outcomes amongst patients treated with CTX and PCN G for complicated VGS bacteremia. Methods This was a single-center, retrospective study of adult patients with ≥1 positive VGS blood culture who were treated with either CTX or PCN G/ampicillin (both included in PCN G arm) between January 2013 and June 2019. The primary outcome was a composite of safety endpoints, including hospital readmission due to VGS or an adverse event (AE) from therapy, Clostridioides difficile infections, treatment modification or discontinuation due to an antibiotic-related AE, and development of extended-spectrum beta lactamase resistance. Secondary outcomes included the individual safety endpoints, VGS bacteremia recurrence, hospital readmission, and all-cause mortality. Results Of 328 patients screened for inclusion, 94 patients met eligibility criteria (CTX n= 64, PCN G n=34). Median age was 68 years (IQR 56–81) and 68% were male. Study patients did not present with critical illness, as reflected by a median Pitt bacteremia score of 0 in the CTX and 1 in the PCN G arms, P=0.764. Streptococcus mitis was the most common VGS isolate and infective endocarditis (IE) was the predominant source of infection. CTX was not significantly associated with increased risk of the primary outcome (14% vs. 27%; P= 0.139). The driver of the composite outcome was hospital readmission due to VGS bacteremia or therapy complications. Results were similar in the subgroup of patients with IE (12.5% vs. 23.5%). No secondary endpoints differed significantly between groups. On multivariate analysis, source removal was a protective factor of the primary outcome (OR 0.1; 95% CI 0.020–0.6771; P= 0.017). Conclusion Despite potential safety concerns with the prolonged use of CTX in complicated VGS bacteremia, this study did not demonstrate a higher rate of treatment failure, adverse events, or resistance. These findings warrant further exploration. Disclosures All Authors: No reported disclosures

scholarly journals Association of blood culture with carbapenem use in pyogenic liver abscess: a two-center retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuangjun He ◽  
Jie Yu ◽  
Hairong Wang ◽  
Lifeng Wang ◽  
Yi Chen ◽  
...  
Keyword(s):  
Blood Culture ◽  
Liver Abscess ◽  
Bacterial Culture ◽  
Multivariate Analyses ◽  
Tertiary Care ◽  
Pyogenic Liver Abscess ◽  
Extended Spectrum Beta Lactamase ◽  
Tertiary Care Centers ◽  
High Positivity Rate ◽  
Positive Results

Abstract Background Highly empiric use of carbapenem in pyogenic liver abscess (PLA) is widespread problem. However, few studies have examined the association between blood culture and carbapenem use in patients with PLA in China. Thus, we conducted this observational study. Methods The data of patients diagnosed with PLA at two comprehensive tertiary care centers from 2014 to 2020 were retrospectively collected. Demographic and clinical data were analyzed, and univariate and multivariate analyses were performed to investigate the association between blood culture and carbapenem use. Subgroup analysis was conducted to explore whether the effect is different in sepsis. Results Blood culture was performed in 110 (46.0%) patients, of whom 44 (40.0%) patients had positive results for bacterial culture. Extended-spectrum beta-lactamase (ESBL)-positive blood culture isolates were detected in 8 (7.3%) patients. The positivity rate of blood culture in sepsis was higher than in non-sepsis (58.1% vs. 32.9%, P = 0.015). Fewer patients who had a blood culture received carbapenem treatment in comparison to patients without blood culture (19.1% vs. 31.8%, P = 0.026). Multivariate analysis showed that blood culture was independently associated with less carbapenem exposure (adjusted odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.16–0.68, P = 0.003), and this effect remained significant in the sepsis subgroup (adjusted OR = 0.17, 95% CI: 0.05–0.53, P = 0.002). Conclusion Blood culture had a high positivity rate and was associated with less carbapenem use in PLA, especially those who developed sepsis. More attention should be paid to performing early blood culture and less carbapenem use in PLA.

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