Blood Stream Infections: Micro-Organisms, Risk Factors and Mortality Rate in Qatif Central Hospital

Abstract

Blood stream infections (BSI) lead to sepsis and septic shock, which continue to be important causes of morbidity and mortality. A vast body of literature has been devoted to this. Worldwide studies about the epidemiology, microbiological etiology and prognosis of BSI have been performed over the last six decades. These have shown changing patterns of the pathogens involved, namely the emergence of gram-negative pathogens as a major cause of bacteremia after the beginning of the antimicrobial era, 1,2 and the recent re-emergence of grampositive pathogens and fungi, especially among the growing population of immunocompromised patients. 3,4 While many studies are available from Western countries, mostly conducted in major teaching or research institutions, little work has been published from the developing countries. Extrapolation of data to hospitals in developing countries may be misleading because of the differing effects of factors such as endemic pathogens, underlying diseases, and antimicrobial prescribing habits.The present study aims to define the pattern of blood stream infections over a five-year period in a general referral hospital in a developing country, to compare it with previously published work from Saudi Arabia and other countries, to point out differences in the spectrum of micro-organisms, community-acquired and hospital-acquired BSI, and to determine the case fatality rate in relation to different micro-organisms and patient age groups. Materials and MethodsThis study was carried out in Qatif Central Hospital (QCH). Qatif is located on the Gulf in the Eastern Province of Saudi Arabia, and the hospital is a 400-bed referral facility that provides all medical services. Data from the hospital's Department of Microbiology and from patients' records were reviewed. Patients with bacteremia and fungemia diagnosed by blood culture from May 1990 through May 1995 were identified and included in the study. The course of each episode of bacteremia or fungemia was followed until its conclusion.Ten and 3 mL of blood samples were drawn aseptically from adult and pediatric patients with suspected BSI, respectively. Each blood sample was divided into two bottles: NR6A (enriched soybean casein digest broth with CO 2 ) for aerobic cultures, and NR7A (prereduced enriched soybean casein digest broth with CO 2 ) for anaerobic cultures. Both bottles were incubated for seven days (eight weeks for brucella) at 37 C, and read daily on a Bactec NR 660 (Becton Dickinson). Subcultures on blood agar, chocolate agar and MacConkey agar were incubated aerobically with CO 2 , and subcultures on blood agar were also incubated anaerobically for 48 hours. A total of 23,704 paired bottles were processed during the study period.The significance of isolates was judged according to the growth in different blood cultures, the clinical findings and the isolates obtained from other body sites. Microorganisms isolated were identified by standard techniques 5 or by API 20 E system. An episode of bacteremia was defined by the isolation of...

Trends in Aetiology and Susceptibility Pattern of Bacterial Pathogens From Bloodstream Infections at a Tertiary Care Teaching Hospital in Western Maharashtra- A 4-Year Analysis

“…This finding has been observed by other recent Indian studies 2015 by Shweta Bohra et al 8 and 2011 by Vanita Rani et al 9 These authors have also noted E. coli and Klebsiella pneumoniae as predominant gram-negative bacteria causing sepsis. However, this finding is not matching with that of studies in USA 10 15,16,17 The possible explanation for the difference could be the difference in blood culture system, the study design, geographical location, nature of patient population, epidemiological difference of the aetiological agents and seasonal variation. 18,19 Amongst the gram-positive bacteria staphylococci (33.3%), coagulase negative staphylococci (29.3%) and enterococci (26.5%) were predominant aetiological agents in our study.…”

Bacterial profile and antimicrobial susceptibility pattern in septicemia suspected patients attending Gondar University Hospital, Northwest Ethiopia

“…were the nine most common noteworthy bacterial pathogens causing BSI. More or less similar observations have been made in cases of bacteraemia in different countries, however, the proportion and predominance of the organisms varied [5,12,18,19,22,24]. …”

“…Several studies in different countries, Jimma Ethiopia, (60.9% and 39.1%) Gondar Ethiopia (70.2% and 29.8%), Zimbabwe (71.9% and 28.1%) Addis Ababa Ethiopia (62.6% and 37.4%), have shown marginally higher prevalence of Gram-positive and lower prevalence of Gram-negative organisms, respectively [12,18,19,21]. On the contrary, Gram-negative bacteria have been reported as the commonest cause of bacteremia in hospitalized febrile patients in developing countries in studies conducted in Nigeria (69.3% and 30.7%), Saudi Arabia (62.2% and 33.8%), Tanzania (69.7%, 30.3%) [17,22,23]. The possible explanation for the difference could be the difference in blood culture system, the study design, geographical location, nature of patient population, epidemiological difference of the etiological agents, and seasonal variation.…”

Epidemiology of bloodstream infection in Saudi Arabia

“…The relatively higher rates (521 microbial isolates, 63%) were observed for the overall HA BSIs than the CA. The varying HA BSI rates (90% (Al-Tawfiq and Abed, 2009); 43% (Elbashier et al, 1998); 53% (Laupland et al, 2009) have been reported earlier.…”