Bacterial Spectrum and Antimicrobial Profile of Pediatric Blood Stream Infection at a Tertiary Care Hospital in Pakistan

Objectives Blood stream infections(BSIs)are the main cause of morbidity and mortality in children worldwide.The present study was carried out to determine the prevalence of BSI with a focus on the identification of the causative agent of BSI,and to further evaluate the antibiotic susceptibility profile of the causing bacterial pathogens.Methods A cross-section study was carried out at the tertiary care hospital in Peshawar,Pakistan from January to December,2018.Blood samples were collected in BACTEC™botdes and standard microbiological protocols were applied for the isolation and identification of bacterial strains.The antibiotic susceptibility tests were performed using disc diffusion method as per the 2014 guideline of Clinical Laboratory Standard Institute(CLSI).Results Of 567 blood cultures in total,111(19.6%)were positive for BSI.Male children were 64%(71/111)and female children were 36%(40/111).For the causative predominant group of microorganisms,Gramnegative bacteria were identified in 79(71.1%)isolates,and Gram-positive bacteria in 32(28.9%)isolates.The common bacteria of isolates were S.typhi(n=35,31.5%),E.coli(n=19,17.1%),S.aureus(n=18,16.2%),K.pneumonia(n=12,10.8%),and Enterococcus species(n=7,6.3%).The 36.7%(29/79)isolates of Gram-negative bacteria were ESBL producers,and 61.1%(11/18)of S.aureus isolates were methicillin resistant.Overall,72.9%isolates were multidrug resistant.Conclusions Gram-negative bacteria were the main cause of pediatric BSIs,where the predominant microorganism was S.卯hi.Remarkably,majority of the S.typhi isolates were resistant to ciprofloxacin.

The Slippery Slope of Sepsis

Mortality, morbidity, early recognition, and treatment of sepsis remain a diagnostic dilemma for clinicians, in addition, the timely diagnosis of sepsis represents an ongoing clinical challenge. This review looks at the challenges of early recognition, the scope of the problem, the immunologic basis of the sepsis cascade, new frontiers related to interventions, and the role of antibiotics in an era of antimicrobial resistance. In Figure 1, once a patient is on the slippery slope of sepsis, the ability to reverse the momentum is challenging;hoping antibiotics, fluid resuscitation, vasopressors may buy time for the immunologic cascade to equilibrate to its homeostatic balance. While the development of septic shock is much more complex than pathogen proliferation, our understanding of the pathogenesis and ability to therapeutically intervene is in its infancy. Patients with sepsis frequently present for urgent medical care with undifferentiated infection and nonspecific symptoms. As 80% of patients with sepsis are initially treated in an Emergency Department, the burden of early recognition and intervention falls squarely on the shoulders of Emergency Department Clinicians. [1] This is an entity that occurs in all age groups, without regard to race, geography, or health status. Survival and mortality related to this clinical entity are poorly understood. Our understanding of sepsis needs to expand beyond the downstream effects and collateral damage of multiorgan dysfunction and failure. Immunologically, the antigenic triggers, be it invasive infection, severe injury, and systemic inflammation without concomitant infection, elicit similar pattern recognition receptors and innate host responses. If you are lucky enough to have survived an acute episode of sepsis, patients with sepsis often develop new adverse sequelae after treatment, a concept called persistent critical illness or post sepsis syndrome, characterized by long-term disability, and worsening chronic health conditions requiring re-hospitalization. [2]

Bacteremia in hemodialysis patients

Infection is a common complication and is the second leading cause of death in hemodialysis patients. The risk of bacteremia in hemodialysis patients is 26-fold higher than in the general population, and 1/2-3/4 of the causative organisms of bacteremia in hemodialysis patients are Gram-positive bacteria. The ratio of resistant bacteria in hemodialysis patients compared to the general population is unclear. Several reports have indicated that hemodialysis patients have a higher risk of methicillin-resistant Staphylococcus aureus infection. The most common site of infection causing bacteremia is internal prostheses; the use of a hemodialysis catheter is the most important risk factor for bacteremia. Although antibiotic lock of hemodialysis catheters and topical antibiotic ointment can reduce catheter-related blood stream infection(CRBSI), their use should be limited to necessary cases because of the emergence of resistant organisms. Systemic antibiotic administration and catheter removal is recommended for treating CRBSI, although a study indicated the advantages of antibiotic lock and guidewire exchange of catheters over systemic antibiotic therapy. An infection control bundle recommended by the Center for Disease Control and Prevention succeeded in reducing bacteremia in hemodialysis patients with either a catheter or arteriovenous fistula. Appropriate infection control can reduce bacteremia in hemodialysis patients.

Fatal hemolysis due to clostridium perfrigens blood stream infection

Here we reported a 59-year-old woman with diabetes who was found to have massive hemolysis associatedwith clostridium （C.） perfringens blood stream infection. She died 13 hours after admission in spite of aggressive treatment. The lady referred to our hospital with high fever, chills, body ache and right hypochondriac pain for 1 day. Physical examination revealed a temperature of 39, heart rate of 110 beats/min, blood pressure of 101/69 mmHg, and a respiratory rate of 25 breaths/min. Pulse oximetry was 94% on room air. Chest auscultation revealed good air movement without rales. Tenderness of right upper abdomen was found. Abnormal laboratory results included white blood cell （WBC） count of 20x109/L with 90.9% neutrophils,

Emergence of antibiotic resistance Pseudomonas aeruginosa in intensive care unit;a critical review

The emergence of antibiotic resistant bacteria in the healthcare is a serious concern.In the Healthcare premises precisely intensive care unit are major sources of microbial diversity.Recent findings have demonstrated not only microbial diversity but also drug resistant microbes largely habitat in ICU.Pseudomonas aeruginosa found as a part of normal intestinal flora and a significant pathogen responsible for wide range of ICU acquired infection in critically ill patients.Nosocomial infection associated with this organism including gastrointestinal infection,urinary tract infections and blood stream infection.Infection caused by this organism are difficult to treat because of the presence of its innate resistance to many antibiotics(b-lactam and penem group of antibiotics),and its ability to acquire further resistance mechanism to multiple class of antibiotics,including Beta-lactams,aminoglycosides and fluoroquinolones.In the molecular evolution microbes adopted several mechanism to maintain genomic plasticity.The tool microbe use for its survival is mainly biofilm formation,quorum sensing,and horizontal gene transfer and enzyme promiscuity.Such genomic plasticity provide an ideal habitat to grow and survive in hearse environment mainly antibiotics pressure.This review focus on infection caused by Pseudomonas aeruginosa,its mechanisms of resistance and available treatment options.The present study provides a systemic review on major source of Pseudomonas aeruginosa in ICU.Further,study also emphasizes virulence gene/s associated with Pseudomonas aeruginosa genome for extended drug resistance.Study gives detailed overview of antibiotic drug resistance mechanism.