Characteristics of Paediatric Blood Stream Infections - an Analysis of Bacteriological Profile and Antimicrobial Susceptibility Pattern in a Tertiary Care Centre from North-East India

Abstract

Introduction

Blood-stream infections have a major impact on the morbidity and mortality of pediatric patients in developing countries. Successful outcome of these infections relies on prompt and timely empiric therapy. The etiological agents and their susceptibility pattern change from time to time even in a same hospital, which warrants continuous surveillance of the characteristics of blood stream infections in this age group. This study was undertaken with an objective of determining the bacterial agents implicated in pediatric blood stream infections and characterization of their antimicrobial susceptibility pattern.

Materials and methods

This was a hospital-based retrospective study. All the patients below the age of 18 years from whom blood culture samples were collected on the suspicion of blood-stream infections during the year 2015 were included. Consecutive, patient-specific, non-duplicate isolates were included for analysis. Patient demographics, bacteriological profile and corresponding antimicrobial sensitivity pattern were analyzed. All the analysis were done using MS-Excel 2016 and MedCalc v12.5.0.

Results

A total of 523 blood cultures were received and 91(17.4%) showed growth of clinically relevant microorganisms (89-monomicrobial and 2–polymicrobial). Gram-positive and Gram-negative bacteria constituted 47(50.53%) and 46(49.47%) respectively. Out of 93 isolates, Staphylococcus aureus(29.03%), Acinetobacter baumannii(20.43%), Klebsiella pneumoniae(10.75%), Pseudomonas spp.(6.45%) and Enterococcus spp.(6.45%) were the most common isolates. Among Staphylococcus, 8(29.62%) were MRSA. Gram-positive cocci were susceptible fully to lincosamides and glycopeptides, but higher proportion of resistance was observed for penicillins, aminoglycosides, fluoroquinolones and 3rd gen-cephalopsorins. Gram-negative bacilli exhibited siginificant resistance to almost all group of available antibiotics – penicillins(75-95%), cephalopsorins(50-87%), aminoglycosides(17-63%), fluoroquinolones (28-36%), carbapenems(23-36%) and beta-lactam/betalactamase inhibitor combinations(17-21%). Further stratifications were done for different subsets of pediatric patients viz. neonates, infants, under-5, under-10 and similar analysis was performed.

 Conclusion

Majority of the isolates were multidrug resistant. These higher percentages necessitates proper infection control measures and warrants larger stratified studies for appropriate empiric antibiotic choice.