Assessment of Anaerobic Culture Incubation Time: A Tertiary Care Center Experience

Abstract Background Currently, there is no consensus on the ideal incubation time for anaerobic cultures. A recent survey of CliniMicroNet reported anaerobic culture incubation times from 2 to 7 days. The goal of this study is to determine the ideal anaerobic culture incubation time and to retrospectively determine if longer incubation time affected management. Methods In this prospective study at Hartford Hospital, an 869-bed level I trauma center, 838 consecutive anaerobic cultures were Gram stained and planted on anaerobic blood, colistin and nalidixic acid (CNA), and kanamycin and vancomycin (KV) agar plates (BD Diagnostic Sparks). Plates were incubated in jars at 35°C and Anoxomat system (Advanced Instruments) was used to create anaerobic conditions. Plates were checked for growth on days 2, 3, 5, and 7. Although not all patient records (EPIC) were available, the type and duration of antibiotics were recorded for more than 100 records. Results Out of 74 cultures from bronchoalveolar lavage (1), bone (2), fluid (21), tissue (14), and wound (36), 53 grew 1 isolate, 15 grew 2 isolates, 5 grew 3 isolates, and 1 grew 4 isolates, for a total of 102 isolates. Sixty percent of isolates were Gram negative and 40% were Gram positive. Of these, 43% were detected on day 2, 21% on day 3, 20% on day 5, and 17% on day 7. In a majority of cases, broad-spectrum antibiotics (vancomycin/cefepime) were administered until culture results were obtained. Conclusion Overall, 73% Gram-negative isolates and 50% Gram-positive isolates were detected on day 2 or 3. Days 5 and 7 yielded 20% and 17% of all isolates, respectively. We conclude and corroborate with CLSI recommendations that anaerobic cultures should be incubated for at least 5 to 7 days.

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Childhood Septicemia in Nepal: Documenting the Bacterial Etiology and Its Susceptibility to Antibiotics

International Journal of Microbiology ◽

10.1155/2014/452648 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Shamshul Ansari ◽

Hari Prasad Nepal ◽

Rajendra Gautam ◽

Sony Shrestha ◽

Puja Neopane ◽

...

Keyword(s):

Antibiotic Susceptibility ◽

Methicillin Resistance ◽

Care Center ◽

Tertiary Care ◽

Diffusion Method ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Disk Diffusion Method ◽

Gram Negative ◽

Microbiological Methods

Introduction. Children are among the most vulnerable population groups to contract illnesses. The varying microbiological pattern of septicemia warrants the need for an ongoing review of the causative organisms and their antimicrobial susceptibility pattern. Therefore, the objective of this study was to document the bacterial etiology of childhood septicemia and its antibiotic susceptibility profile.Methods.Cross-sectional type of study in 1630 suspected patients was conducted at CMCTH from January 2012 to December 2013. Blood samples were collected aseptically for culture. The organisms grown were identified by standard microbiological methods recommended by American Society for Microbiology (ASM) and subjected to antibiotic susceptibility testing by modified Kirby-Bauer disk diffusion method. Methicillin resistance was confirmed using cefoxitin and oxacillin disks methods.Results.Septicemia was detected in 172 (10.6%) cases. Among Gram-positive organisms, coagulase negative staphylococci (CoNS) were leading pathogen andAcinetobacterspp. were leading pathogen among Gram-negative isolates. Vancomycin, teicoplanin, and clindamycin were the most effective antibiotics against Gram-positive isolates while amikacin was effective against Gram-positive as well as Gram-negative isolates. Methicillin resistance was detected in 44.4% ofStaphylococcus aureus.Conclusions. This study has highlighted the burden of bacterial etiology for septicemia among children in a tertiary care center of central Nepal.

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Antibiotic Susceptibility Profile of respiratory pathogens obtained at tertiary care hospital from western Nepal

Nepal Journal of Biotechnology ◽

10.3126/njb.v7i1.26944 ◽

2019 ◽

Vol 7 (1) ◽

pp. 1-7

Author(s):

Deepak Subedi ◽

Surya Prasad Devkota ◽

Dharm Raj Bhatta ◽

Binita Koirala Sharma ◽

Ashmita Paudel ◽

...

Keyword(s):

Antibiotic Susceptibility ◽

Care Center ◽

Tertiary Care ◽

Clinical Samples ◽

Lower Sensitivity ◽

Respiratory Pathogens ◽

Care Hospital ◽

Gram Positive ◽

Gram Negative ◽

Sensitivity Rate

The prevalence and drug resistance of the respiratory pathogens is increasing gradually in Nepal. However, their detail study is rare in the western region of Nepal. Hence, this study was carried out to know the incidence and antibiotic susceptibility profile of the respiratory pathogens obtained at a tertiary care center located at Pokhara. 139 pathogens were isolated from 460 clinical samples included. Significant pathogens were Gram-negative bacteria 94 (67.62%), followed by 28 (20.15%) Candida, and Gram-positive isolates 17 (12.23%). The growth rate was significantly higher for sputum samples in comparison to throat swabs. Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter were significant Gram-negative isolates while Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes were Gram-positive pathogens. Sensitivity rate was higher for colistin and imipenem among Gram-negative isolates while lower sensitivity was for cefepime. Vancomycin was effective against all tested Gram-positive isolates while erythromycin and ciprofloxacin were less effective.

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Bacterial Diversity, Antibiotic Resistance, and the Risk of Lower Limb Amputation in Younger and Older Individuals With Diabetic Foot Infection

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734621992290 ◽

2021 ◽

pp. 153473462199229

Author(s):

Stefan Dörr ◽

Ann-Kathrin Holland-Letz ◽

Gregor Weisser ◽

Apostolos Chatzitomaris ◽

Ralf Lobmann

Keyword(s):

Bacterial Diversity ◽

Diabetic Foot ◽

Care Center ◽

Bacterial Load ◽

Limb Amputation ◽

Older Individuals ◽

Foot Care ◽

Gram Positive ◽

Gram Negative ◽

Diabetic Foot Infection

Introduction A diabetic foot infection (DFI) contributes to high mortality and morbidity in diabetics due to its often rapid progressive and intricately treatable infection. DFIs are usually a polymicrobial infection and characterizing the entire bacterial load is still challenging. Prompt and effective treatment of DFI is nevertheless mandatory to safe limbs and lives. It is therefore crucial to know the local pathogen spectrum and its antibiotic susceptibility. Methods and Material For a 12-month period, we investigated 353 individuals with infected diabetic foot ulcer, their bacterial diversity, and antimicrobial susceptibility at fist-time visit in a Diabetic Foot Care Center in southern Germany. Results Cultures yielded 888 species, most of them gram-positive cocci (primary Staphylococcus aureus). The gram-negative sector was mainly formed by Pseudomonas aeruginosa and Enterobacteriacae. Because the prevalence of multiresistant species was surprisingly low (0.9% of isolated strains), we suggest penicillins with β-lactamase inhibitor in case of gram-positive–dominated infection or piperacillin/tazobactam or rather carbapenems with equal efficacy when gram-negative species are involved.

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Asymptomatic Bacteriuria among Pregnant Women Attending Tertiary Care Hospital in Lucknow, India

Dubai Medical Journal ◽

10.1159/000513626 ◽

2021 ◽

pp. 1-8

Author(s):

Naimshree Sonkar ◽

Malay Banerjee ◽

Suman Gupta ◽

Absar Ahmad

Keyword(s):

Haemoglobin Level ◽

Pregnant Women ◽

Antimicrobial Susceptibility ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Asymptomatic Bacteriuria ◽

Care Hospital ◽

Gram Positive ◽

Gram Negative ◽

E Coli

Introduction: Asymptomatic bacteriuria (ASB) is the presence of actively multiplying bacteria within the urinary tract with absence of any symptoms, resulting in adverse pregnancy outcomes. This research study was done in order to review prevalence, antimicrobial susceptibility profile, and factors associated with ASB occurring in female patients who are pregnant and being treated at a tertiary care hospital in Lucknow, India. Method and Materials: This is a cross-sectional study done among 216 pregnant women attending a hospital for antenatal check-ups. Clean catch midstream urine samples were collected and examined microscopically, and semi-quantitative culture was done on blood agar and MacConkey agar. Isolates were identified by colony morphology and biochemical tests, and antimicrobial susceptibility testing was done by using the Kirby-Bauer method. Results: Of the 216 pregnant women, 36 (16.7%) tested positive for ASB. The female gestational period, haemoglobin level, and BMI were significantly associated with ASB. Logistic regression also showed that higher haemoglobin level was less likely to ASB (AOR = 0.42, 95% confidence interval: 0.202–0.88, p = 0.021). The predominant and usual isolates were E. coli (n = 22, 61.1%), followed by Cons (n = 6, 16.7%), and S. aureus (3, 8.3%). All Gram-negative isolates were mostly sensitive to most of the drugs like piperacillin-tazobactam, cefepime, nitrofurantoin, and meropenem but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to ampicillin, vancomycin, linezolid, and nitrofurantoin but 100% resistant to co-trimoxazole. Conclusion: The present study shows the existence of ASB was 16.7% among women who are pregnant. Pregnancy duration, haemoglobin level, and BMI were significantly associated with ASB. The isolates identified more frequently were E. coli (61.16%), Cons (16.7%), and S. aureus (8.3%). All isolates which were Gram-negative were mostly sensitive to most of the drugs but were 100% resistant to ampicillin. Similarly, Gram-positive isolates were sensitive to most of the drugs but 100% resistant to co-trimoxazole.

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Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1041 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s397-s398

Author(s):

Ayush Lohiya ◽

Samarth Mittal ◽

Vivek Trikha ◽

Surbhi Khurana ◽

Sonal Katyal ◽

...

Keyword(s):

Surveillance System ◽

Trauma Center ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Surgical Site Infections ◽

Trauma Patients ◽

Care Hospital ◽

Middle Income ◽

Predominant Pathogen ◽

Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

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AEROBIC BACTERIOLOGICAL PROFILE WITH ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF PUS SAMPLES AT A TERTIARY CARE HOSPITAL IN JAIPUR

10.36106/ijsr/2304773 ◽

2021 ◽

pp. 65-67

Author(s):

Hemendra K Sharma ◽

Niketa Gupta ◽

Mahesh Yadav ◽

Aruna Vyas ◽

Rajni Sharma

Keyword(s):

Antimicrobial Susceptibility ◽

Tertiary Care ◽

Morbidity And Mortality ◽

Diffusion Method ◽

Care Hospital ◽

Susceptibility Pattern ◽

Gram Positive ◽

Gram Negative ◽

Inappropriate Use ◽

Antimicrobial Susceptibility Pattern

Background: Pyogenic infections can be caused by various microorganisms and may co-exist as poly microbial infections which require antibiotic therapy. The inappropriate use of antibiotics has led to major problems of MDRO's contributing to morbidity and mortality. Even though the bacteriological prole of pus samples in many studies remain the same, antimicrobial susceptibility pattern of these isolates has shown a lot of variation. This study was conducted to assess bacteriological prole of pus samples and their antimicrobial susceptibility pattern Materials and Methods:Aretrospective study was carried out from April to June 2021. 540 pus culture aerobic bacterial isolates were included. The samples were cultured on Blood and MacConkey agar. After aerobic incubation at 37oC for 18-24 hrs, organisms were identied by conventional bacteriology methods as per laboratory protocol and antimicrobial susceptibility was tested by Kirby Bauer disc diffusion method as per CLSI 2020 guideline. Results: Out of 540 pus isolates , 452(83.7%)were gram negative bacili and 88(16.3%) were gram positive cocci Pseudomonas spp. 173(31.9%), was most common gram negative isolate while S.. aureus 66(12.19%) was most common Gram positive isolate. Most of gram negative isolates were susceptible to Imipenem and Polymyxin and gram positive isolates to vancomycin and linezolid . Conclusion: To combat resistance irrational use of antibiotics should be avoided. Also regular surveillance helps in implementing better therapeutic strategies to reduce morbidity and mortality

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Microbiological Screening and Antimicrobial Sensitivity Profiling of Wound Infections in a Tertiary Care Hospital of Bangladesh

European Journal of Medical and Health Sciences ◽

10.34104/ejmhs.020.01010106 ◽

2020 ◽

pp. 101-106

Keyword(s):

Wound Infection ◽

Primary Care Physicians ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Treatment Modalities ◽

Care Hospital ◽

Bacterial Isolates ◽

Gram Positive ◽

Gram Negative ◽

Antimicrobial Sensitivity

Wound infection is a major problem in hospitals in developing countries. Wound infection causes morbidity and prolonged hospital stay thus this prospective study was conducted for a period of seven months (January 2019 to July 2019). A total of 217 specimens (wound swabs and pus exudates) from wound infected patients in a Tertiary Care Hospital in Bangladesh. A retrospective study of the microbiological evaluation was done by cultural growth as well as Gram staining and biochemical examination to identify the bacterial isolates. Finally, the antimicrobial vulnerability testing was performed by Kirby-Bauer disc diffusion conventional method. A total of 295 samples were tested. Out of which 217 (73.5%) were found culture positive. E. coli was the most predominant gram-negative isolates whereas Staphylococcus aureus and Coagulase-negative Staphylococcus were the most commonly isolated gram-positive organisms. Antimicrobial sensitivity profile of bacterial isolates revealed imipenem, meropenem, amikacin, and nitrofurantoin to be the most effective antimicrobials against gram-negative isolates, whereas imipenem, meropenem, amikacin, nitrofurantoin, amoxiclav, and gentamicin were the most effective drugs against gram-positive isolates. The result of this examination contributes to the identification of basic causative microbes involved in wound infection and findings of antibiotic susceptibility patterns can be helpful for primary care physicians to optimize the treatment modalities, articulate policies for empiric antimicrobial therapy, and to minimize the rate of infection among wound infected patients.

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Bacteriological profile and antibiogram of cancer patients admitted in intensive care unit of a tertiary care cancer hospital in central Kerala

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205323 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4450

Author(s):

Sanjana Ramakrishnan ◽

Sourabh Radhakrishnan ◽

Sonu Lazar Cyriac

Keyword(s):

Cancer Patients ◽

Bacterial Infections ◽

Tertiary Care ◽

Gram Positive ◽

Cross Sectional ◽

Gram Negative ◽

Mortality And Morbidity ◽

E Coli ◽

Resistance To Penicillin ◽

Study Laboratory

Background: Opportunistic bacterial infections remain a serious morbidity among cancer patients. This study was aimed to determine the bacteriological and antibiotic profile of cancer patients admitted to the ICU of a tertiary care centre.Methods: Cross sectional study was done among cancer patients admitted in the Oncology neutropenic ICU during the period from August 2017 to July 2019. All patients admitted with a proven diagnosis of cancer for whom at least one bacterial culture was sent from any site were included in the study. Laboratory on culture reports were obtained from patient files and analysed.Results: A total of 278 samples from 256 patients (60±11.6 years) were analysed. Among the 111/278 positive cultures, 29 were blood samples and 1 was a pleural fluid sample. Gram negative organisms were 62.1% with Escherichia coli (25, 36.2%) as prevalent. Among the 37.8% gram positives, Staphylococcus aureus (18. 42.8%) was prevalent. Most of the E. coli strains showed highest resistance to ceftazidime (96%) and highest sensitivity to amikacin. The commonest gram-positive organism, Staphylococcus species were 100 % sensitive to vancomycin and linezolid and 100 % resistance to penicillin. Conclusions: E. coli (gram negative) showed highest resistance to ceftazidime and sensitivity to amikacin. S. aureus (gram positive) was sensitive to vancomycin and linezolid and resistance to penicillin. An antibiogram for cancer patients helps the clinician to initiate an appropriate empirical antibiotic therapy to reduce mortality and morbidity.

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Predictive Factors for the Development of Central Line–Associated Bloodstream Infection Due to Gram-Negative Bacteria in Intensive Care Unit Patients After Surgery

Infection Control and Hospital Epidemiology ◽

10.1086/524334 ◽

2008 ◽

Vol 29 (1) ◽

pp. 51-56 ◽

Cited By ~ 32

Author(s):

Pranavi V. Sreeramoju ◽

Jocelyn Tolentino ◽

Sylvia Garcia-Houchins ◽

Stephen G. Weber

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bloodstream Infection ◽

Predictive Factors ◽

Tertiary Care ◽

Central Line ◽

Gram Negative Bacteria ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria

Objectives.To examine the relative proportions of central line-associated bloodstream infection (BSI) due to gram-negative bacteria and due to gram-positive bacteria among patients who had undergone surgery and patients who had not. The study also evaluated clinical predictive factors and unadjusted outcomes associated with central line-associated BSI caused by gram-negative bacteria in the postoperative period.Design.Observational, case-control study based on a retrospective review of medical records.Setting.University of Chicago Medical Center, a 500-bed tertiary care center located on Chicago's south side.Patients.Adult intensive care unit (ICU) patients who developed central line-associated BSI.Results.There were a total of 142 adult patients who met the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System definition for central line-associated BSI. Of those, 66 patients (46.5%) had infections due to gram-positive bacteria, 49 patients (34.5%) had infections due to gram-negative bacteria, 23 patients (16.2%) had infections due to yeast, and 4 patients (2.8%) had mixed infections. Patients who underwent surgery were more likely to develop central line-associated BSI due to gram-negative bacteria within 28 days of the surgery, compared with patients who had not had surgery recently (57.6% vs 27.3%; P = .002). On multivariable logistic regression analysis, diabetes mellitus (adjusted odds ratio [OR], 4.6 [95% CI, 1.2-18.1]; P = .03) and the presence of hypotension at the time of the first blood culture positive for a pathogen (adjusted OR, 9.8 [95% CI, 2.5-39.1]; P = .001 ) were found to be independently predictive of central line-associated BSI caused by gram-negative bacteria. Unadjusted outcomes were not different in the group with BSI due to gram-negative pathogens, compared to the group with BSI due to gram-positive pathogens.Conclusions.Clinicians caring for critically ill patients after surgery should be especially concerned about the possibility of central line-associated BSI caused by gram-negative pathogens. The presence of diabetes and hypotension appear to be significant associated factors.

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Detection of bla NDM-1 Encoding Imepenemase among the Imipenem-Resistant Gram-Negative Bacilli Isolated from Various Clinical Samples at a Tertiary Care Hospital of Eastern Nepal: A Descriptive Cross-Sectional Study

International Journal of Microbiology ◽

10.1155/2020/8861204 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

S. Gautam ◽

N. R. Bhattarai ◽

K. Rai ◽

A. Poudyal ◽

B. Khanal

Keyword(s):

Care Center ◽

Tertiary Care ◽

Hospital Setting ◽

Clinical Samples ◽

Care Hospital ◽

Disc Diffusion ◽

Diffusion Test ◽

Cross Sectional ◽

Gram Negative ◽

Synergy Test

Background. Carbapenem resistance among Gram-negative isolates caused by the production of the metallo-β-lactamase (MBL) enzyme is being increasingly reported worldwide. One of the newly emerged metallo-β-lactamases is New Delhi metallo-β-lactamase. Data regarding its occurrence in hospital setting and percentage prevalence among different Gram-negative bacterial isolates are lacking in our part. This study has been undertaken for determining the presence of the bla NDM-1 gene among the clinical isolates of imipenem-resistant Gram-negative bacteria in a tertiary care center in Dharan, Nepal. Methods. A total of 75 imipenem-resistant Gram-negative isolates were studied. These were screened for metallo-β-lactamase (MBL) production by phenotypic assays such as double-disc synergy test (DDST) and combined disc diffusion test (CDDT). PCR was performed for the molecular detection of gene NDM-1. Ten-disc method was performed to detect the presence of ESBL, AmpC, carbapenamase, and K1 β-lactamase production. Results. Using the molecular method, bla NDM-1 was detected in 36% of the isolates. Phenotypically, double-disc synergy test (DDST) and combined disc diffusion test (CDST) detected MBL production in 38.7% and 37.3% of the isolates, respectively. Ten-disc method detected ESBL in 26.6% of the isolates, but none of the isolates was found to be AmpC, carbapenamase, and K1 β-lactamase producers. Conclusion. A high percentage of the NDM-1 producer was noted among imipenem-resistant GNB. Apart from performing only antimicrobial sensitivity test, phenotypic and molecular screening should be employed to find out the actual number of metallo-β-lactamase producers and the existence of the resistance gene.

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