Sandhya Bhat K

Abstract

Introduction: Automated blood culture systems provide continuous monitoring of bacterial growth, and time to positivity (TTP), may be used as good tool for diagnosis of blood stream infections. Objective of the study was to document bacterial profile and their susceptibility pattern and to evaluate the association between the TTP and clinical outcome in patients with BSIs. Materials and Methods: A cross-sectional study was conducted (after obtaining waiver of consent from institute ethics committee), on 75 patients with positive blood culture. Laboratory data such as TTP, bacterial pathogen isolated from positive blood cultures and their susceptibility pattern, clinical parameters such as demographic characteristics, source of BSIs, severity of infection as per various clinical scores were analysed for patients with TTP ?10 hours and > 10 hours using univariate analysis. Results: was the commonest gram-negative bacterial isolate (33.3%), and Staphylococcus aureus was the commonest gram-positive bacterial isolate (22.2%). Antimicrobial resistance rate in GNB was very high for cefotaxime (57%), ciprofloxacin (44%) and among gram-positive bacterial isolates was high for clindamycin (56.5%), and cefotaxime (50%). In the study, median TTP was 13 hours and short TTP of ?10h was observed for , and . There were statistically significant differences observed for end stage renal disease, diabetes association and neutropenia patients with short TTP. Conclusion: Time to positivity is a useful tool for to-measure laboratory prognostic factor for patients with bacteremia. However, further studies with larger sample size, may be required to define its usefulness and the optimal cut-off points.   Keywords: Time to positivity, Prognostic factor, Bacteremia

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Abstract

Introduction: Blood stream infections continue to be the major cause of mortality and morbidity and hence early availability of direct susceptibility reports can be lifesaving. This study aims to ascertain if direct susceptibility testing (DST) can be used as a diagnostic tool in bacteremic patients and to correlate the results of both DST and standard antimicrobial susceptibility reports (AST), thereby serving to benefit both the patients and also to reduce the irrational use of antibiotics. Materials and Methods: An experimental study was carried out after obtaining waiver of consent, in a tertiary care centre. A total of 37 patients were included in the study after careful consideration of the inclusion and exclusion criteria. Gram staining report, bacteriological profile, direct susceptibility report, antimicrobial susceptibility report of all the isolates were documented. Statistical analysis was done by using IBM SPSS software. Results: Overall prevalence of sepsis was 40.5%. Gram negative bacteria were more commonly isolated (83.8) and Escherichia coli was the commonest isolate (51.4%). The antimicrobial resistance was observed maximum for amoxicillin/clavulanic acid (66.7%), ceftriaxone (60.6%), Cefotaxime (57.6%) and least for meropenem (9.1%), imipenem (6.1%). On comparison of DST with AST among 28 gram-negative Enterobacteriaceae isolates 15 minor errors (4.8%) and three major errors (0.97%) were recorded, with maximum errors being documented for piperacillin/tazobactam with five minor errors (17.9%) and one major error (3.6%). Conclusion: DST is an important tool for early institution of targeted therapy and should be considered as one of the step towards antibiotic stewardship intervention. Keywords: Blood stream infection, Blood culture, Direct susceptibility test, Disk diffusion

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Streptococcus pseudoporcinus is a beta-hemolytic Gram-positive, catalase-negative, nonmotile coccus arranged in short chains, usually found in the female genitourinary tract. Only a few human infections associated with this organism have been reported till date. Streptococcus pseudoporcinus is usually found as colonizer of female genital tract, has been rarely associated with bacteremia. We are reporting a rare case of Streptococcus pseudoporcinus causing bacteremia in patients with respiratory failure and coronary artery disease, who was treated with clindamycin and piperacillin/tazobactam. This case report illustrates the potential of these bacteria to cause severe invasive and life-threatening disease.   Keywords: Bacteremia, Streptococcus pseudoporcinus, Beta­hemolytic streptococci, Respiratory failure

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Background: Bloodstream infections (BSIs) may cause significant adverse clinical outcomes among patients affected by Coronavirus disease 2019 (COVID-19). This study was conducted with the objective to characterize the bacterial isolates and their susceptibility pattern and to document the patient outcome as well as skin disinfection measures followed during the venepuncture for the blood collection procedure. Materials and Methods: All blood cultures received from COVID-19 patients admitted in various COVID care wards and ICUs for a period of two years from June 2020 to May 2022 were included in the study. An automated BacT/ALERT system was used for blood culture. The microbial identification and antimicrobial susceptibility testing were done by standard methods. Patient demographic and treatment details and infection control and prevention practices followed during the blood specimen collection were documented. Results: Out of 172 COVID-19-positive patients blood samples were sent for blood culture with clinical suspicion of sepsis. Out of these, 4.2% were positive. The median age of COVID-19 patients with positive blood cultures was 55 years and about 67% of patients had associated comorbidities. About 31% of patients were admitted to ICUs for their management. The blood culture positivity was documented more among patients with ICU admission, underlying comorbidities, and the presence of an indwelling device. Gram-positive bacterial isolation was more than gram-negative bacteria. About 54% showed clinical improvement at the time of discharge and death was recorded in 19% of patients. There was a lack of strict adherence to the aseptic techniques during the venepuncture for blood collection. Conclusions: The incidence of bloodstream infections documented was low for COVID-19 patients. Hence, empirical antimicrobial agents should be used with care and prompt discontinuation should be done on clinical improvement and based on the microbiology culture report.   Keywords: Bacteremia, Blood culture, Bloodstream, Comorbidities, COVID- 19, Antimicrobial resistance.

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