Pathogenic spectrum of blood stream infections and resistance pattern in Gram-negative bacteria from Aljouf region of Saudi Arabia.

Altaf Bandy,Abdulrahman Hamdan Almaeen,Grzegorz Woźniakowski

doi:10.1371/journal.pone.0233704

Abstract

The pathogenic spectrum of bloodstream infections (BSIs) varies across regions. Monitoring the pathogenic profile and antimicrobial resistance is a prerequisite for effective therapy, infection control and for strategies aimed to counter antimicrobial resistance. The pathogenic spectrum of BSIs in blood cultures was analysed, focusing on the resistance patterns of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae, in Aljouf region. This descriptive cross-sectional study analysed the culture reports of all non-duplicate blood samples collected from January 1 to December 31, 2019. Antibiograms of A. baumannii, E. coli, and K. pneumoniae were analysed for antibiotic resistance. The frequency and percentages of multi-drug, extensively-drug, pan-drug and carbapenem resistance were calculated. Of the 222 bloodstream infections, 62.2% and 36.4% were caused by gram-negative and gram-positive bacteria, respectively. Most BSIs occurred in patients aged ≥60 years (59.5%). Among the 103 isolates of the studied Gram-negative bacteria (GNB), 47.6%, 38.8%, and 2.9% were multi-drug, extensively drug and pan-drug resistant respectively. 46% of K. pneumoniae isolates were carbapenemase producers. Resistance to gentamycin, 1st-4th generation cephalosporins, and carbapenems was observed for A. baumannii. More than 70% of E. coli isolates were resistant to 3rd- and 4th-generation cephalosporins. Klebsiella pneumoniae presented a resistance rate of >60% to imipenems. Gram-negative bacteria dominate BSIs, with carbapenem-resistant K. pneumoniae most frequently detected in this region. Resistant GNB infections make it challenging to treat geriatric patients. Regional variations in antimicrobial resistance should be continually monitored.

Highlights

Bloodstream infections (BSIs) with resistant microorganisms are associated with a higher risk of mortality of hospitalized patients [1]
More than 70% of E. coli isolates were resistant to 3rd- and 4th-generation cephalosporins
Gram-negative bacteria dominate BSIs, with carbapenem-resistant K. pneumoniae most frequently detected in this region

Summary

Introduction

Bloodstream infections (BSIs) with resistant microorganisms are associated with a higher risk of mortality of hospitalized patients [1]. The length of hospital stay is increased in patients with multidrug-resistant (MDR) infections, resulting in an increased risk of mortality and other infections, resulting in high health expenditures [4]. The clinical outcome of patients having BSIs caused by carbapenem resistant Escherichia coli and Klebsiella pneumoniae is poor with a mortality as high as 50%. A recent study from the Aseer region reported an MDR rate as high as 69% for Acinetobacter baumannii, with only 0.05% and 0.04% of these bacteria susceptible to imipenem and meropenem, respectively [13]. The pathogenic spectrum of BSIs in blood cultures was analysed, focusing on the resistance patterns of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae, in Aljouf region.

Methods

Results

Conclusion