Blood Culture Isolates Research Articles

1061. Decreased Utilization of Piperacillin–Tazobactam for Escherichia coli and Klebsiella Bacteremia due to Selective Susceptibility Reporting

BackgroundOver 2 million people in the United States are diagnosed with antibiotic-resistant infections annually. The Infectious Diseases Society of America (IDSA) recommends cascade reporting of antibiotic susceptibility data by the clinical microbiology laboratory as an intervention to decrease resistance, though this is based on low-quality evidence.MethodsWe conducted a retrospective study to assess the effect of cascade susceptibility reporting on prescribing practices and patient outcomes. A cascaded testing algorithm was executed wherein susceptibility data for piperacillin–tazobactam (PT) was suppressed from the susceptibility report if an organism was susceptible to ceftriaxone. Patients with positive monomicrobial blood cultures with non-ESBL Escherichia coli (E. coli) or Klebsiella isolates in blood cultures and receiving empiric PT were included. Data were collected one year prior and one year after cascading protocol implementation, and included patient demographics, length of stay (LOS), duration of antibiotics, time to de-escalation, and adverse events including acute kidney injury (AKI) and Clostridioides difficile infection (CDI).Results212 patients (108 pre-intervention and 104 post-intervention) were included. 87% of patients were de-escalated from PT pre-intervention, while 90% were deescalated post-intervention. Mean time to deescalation decreased from 30 hours before to 17 hours after cascade implementation (P = 0.02) (Figure 1). Median LOS decreased from 15 to 10 days following the intervention (P = 0.12). While the rate of AKI increased from 14 to 19% post-intervention (P = 0.89), the rate of CDI (2 vs. 2 patients) was comparable among both cohorts (P = 0.97) (Figure 2).ConclusionWhile cascade susceptibility reporting is recommended by the IDSA as a tool for antimicrobial stewardship, this recommendation has weak support due to paucity of data. In this study, we found that selective susceptibility reporting has the potential to decrease the use of PT and to reduce LOS in patients with E. coli and Klebsiella bacteremia. Further research to better identify patient populations most impacted by a cascade algorithm and its overall effectiveness as a stewardship tool is needed. Disclosures All authors: No reported disclosures.

2686. strong>Bloodstream Infection Survey in High-Risk Oncology Patients (BISHOP) with Fever and Neutropenia (FN): Viridans Group Streptococcus Emerges as an Important Pathogen

BackgroundIn this prospective nation-wide survey of bloodstream isolates associated with first episode of FN in high-risk cancer patients from 14 US cancer centers (December 2016 and June 2018), viridans group Streptococci (VGS) were the most common Gram-positive isolate. We sought to clinically and microbiologically characterize VGS bloodstream infections (BSI).MethodsAmong 343 patients,we compared 90 with VGS vs 253 with non-VGS BSI. Minimum inhibitory concentrations for blood culture isolates were determined by broth dilution for selected agents at our reference microbiology laboratory (UNMC). Clinical data were electronically captured in RedCap, including local site isolate identification and confirmatory reference lab identification via MALDI. Categorical and continuous variables were assessed via chi-square and Mann–Whitney U tests, respectively.ResultsNinety-two VGS isolates were identified among 90 FN patients, representing 27% of all BSI isolates. S. mitis or oralis comprised 64 (70%) of VGS. There were no differences between age, sex, and primary diagnosis (50% with AML) among the 2 groups; 1/3 were HSCT recipients. Fluoroquinolone prophylaxis was used in 64 (71%) vs. 139 (55%), P < 0.01, in VGS vs non-VGS groups. Critical illness composite (new need for pressor(s), mechanical ventilation or death within 30 days) was 6 (7%) vs. 44 (17%), P = 0.01, in the VGS vs non-VGS groups. Figure 1 displays an overview of antibiotic susceptibilities for 79 testable isolates. VGS susceptibilities to levofloxacin, penicillin, and ceftriaxone were 39%, 47%, and 94%, respectively.ConclusionVGS are common pathogens in FN patients. Prior fluoroquinolone prophylaxis use may be a risk factor. VGS BSI was not associated with increased critical illness compared with non-VGS. Finally, assuming ceftriaxone susceptibility confers that of cefepime, >90% of VGS are susceptible to empiric FN cefepime regimens. Disclosures All authors: No reported disclosures.

Evaluation of microorganisms isolated from blood cultures and their susceptibility profiles to antibiotics in five years period

Aim: In starting antibiotic treatment to know the distribution of infectious agents and the antibiotic resistance rates is vital especially in critically ill patients to prevent disease progression. In this study we aimed to determine the distribution and antimicrobial resistance patterns of blood culture isolates obtained in a tertiary center. Methods: The microbiological laboratory records between January 2014 and December 2018 were retrospectively reviewed. Each conventional aerobic blood culture bottle per patient with positive results was recorded with the antimicrobial susceptibility profiles of the bacteria isolated. Descriptive statistics (number, percentage, mean and median) were performed. Comparison of descriptive data between groups was performed with cross tables and chi square test. One-way ANOVA test was used to compare the antibiotic resistance rates between spp. Results: A total of 66004 blood cultures were analyzed in this cross-sectional study. Of the 3882 (21.0%) positive results, 3256 (4.9%) were identified as contamination. The most commonly isolated microorganisms were Coagulase negative staphylococcus, Escherichia coli, Klebsiella spp., Staphylococcus aureus and Acinetobacter spp. Extended spectrum β-lactamase (ESBL) positivity was determined in 236 (62.4%) isolates of E.coli, and 186 (56.8%) isolates of Klebsiella spp. Vancomycin resistance showed a significant increase in Enterococcus spp. in time. E.coli did not show any resistance to imipenem, meropenem, tigecycline or colistin. Methicillin susceptible Staphylococcus aureus (MSSA) and methicillin resistant Staphylococcus aureus (MRSA) did not show any resistance to vancomycin, teicoplanin, linezolid or daptomycin. In Enterococcus spp., tigecycline resistance was 1.9%, while daptomycin and linezolid resistance were not determined. The most effective resistance agent to Acinetobacter spp. and Pseudomonas spp. was colistin. Fungal infection was detected in 156 patients. Candida albicans and Candida parapsilosis complex were the most common isolates. Conclusion: Antibiotic resistance rates are increasing in all over the world. Rational antibiotic usage may aid the clinicians to overcome this condition. Epidemiological data is important in this regard.

3066 Recurrent Streptococcus bovis Bacteremia in the Absence of Colonic Neoplasm

INTRODUCTION: Associations between Streptococcus bovis (S. bovis) bacteremia and colorectal cancers and colonic adenomas have been reported in the medical literature since the 1970's. We are reporting an extremely rare case of recurrent Streptococcus bovis biotype II bacteremia in the absence of colonic neoplasm. CASE DESCRIPTION/METHODS: 53-year-old man with diffuse large B-cell lymphoma – in remission (treated with chemotherapy and autologous stem cell transplantation), nesidioblastosis (treated with partial pancreatectomy/splenectomy) and hypertension was admitted to the hospital with severe sepsis. Of note, one month prior to his presentation, he was admitted to the hospital for S. bovis bacteremia. Examination: temperature 37.8°C, HR 104/minute, respiratory rate 28/minute, BP 101/51 mmHg and Spo2 98% on 4 liters nasal cannula. Laboratory data: white cell count 32.83 × 103/μL, hemoglobin 13.0 g/dL, platelets 210 × 103/μL, sodium 139 mEq/L, potassium 3.2 mEq/L, chloride 95 mEq/L, bicarbonate 22.6 mEq/L, creatinine 1.3 mg/dL, AST 124 IU/L, ALT 152 IU/L, alkaline phosphatase 139 IU/L, total bilirubin 0.3 mg/dL, lactic acid 6.6 mmol/L. Blood culture – positive for S. bovis. Infective endocarditis was ruled out by an echocardiogram. Patient was given intravenous antibiotic therapy and follow up blood cultures did not demonstrate any growth. Due to the association between S. bovis bacteremia and colonic malignancy, colonoscopy was performed. Patient was found to have a small, hyperplastic polyp in the cecum and diverticulosis involving the ascending, sigmoid and descending colon. DISCUSSION: S. bovis is a rare cause of bacteremia accounting for &lt;1% of blood culture isolates. It has a high mortality rate of 26-70% and has been associated with colorectal malignancy, endocarditis, and hepatic dysfunction. There are two S. bovis biotypes (I and II) and the prevalence of colorectal neoplasm in patients with S. bovis biotype II bacteremia (23%) is substantially lower than biotype I (70%). Our patient had S. bovis biotype II bacteremia and did not have evidence of malignancy/adenoma(s) in the colonoscopy. To our knowledge this is the first case of recurrent S. bovis bacteremia reported in the medical literature in the absence of both colorectal cancer and colonic adenoma.

Detection of bla and bla OXA-48 genes in Gram-negative isolates from neonatal sepsis in central of Iran

The aim of this study was to determine the prevalence of neonatal sepsis with a focus on antibiotic resistance and the frequency of the bla CTX-M-15 and bla OXA-48 genes in Gram-negative isolates. A total of 108 Umbilical Cord Blood (UCB) and 153 peripheral blood samples were cultured via BACTEC from May 2017 to June 2018. The bacterial isolates were identified using phenotypic and genotypic analyses. The antibiotic susceptibility profile of the isolates was determined by disk diffusion. PCR was used to determine the frequency of β-lactamase genes. Among the 153 infants, 21 (13.7%) proved positive for sepsis. Escherichia coli, Staphylococcus epidermidis and Klebsiella pneumoniae were the most frequent isolates in the peripheral blood cultures. E. coli and Stenotrophomonas maltophilia were isolated from two UCB cultures. The highest resistance among the Gram-positive strains was to cefixime, ceftriaxone, cefotaxime and clindamycin. In the Gram-negative bacteria the highest rates of resistance were to ampicillin (91.7%). The frequency of bla OXA-48 and bla CTX-M-15 genes was 25% and 50%, respectively. The high antibiotic resistance among the isolates reveals the importance of monitoring antibiotic consumption and improving control standards in the health care system, especially in neonatal wards.

Bacteriological profile and antibiogram of blood culture isolates from paediatric patients with special reference to ESBL and MRSA in a tertiary care centre

Introduction and Objective: Blood stream infections are important causes of morbidity and mortality in neonates and children. Blood culture remains the gold standard for their diagnosis. Emergence of multi drug resistant bacterial strains is a major problem in the management of sepsis. The antimicrobial susceptibility patterns help to guide the choice of empiric antimicrobial regimen for the patients with bacteremia and septicaemia. The present study was undertaken to identify the common bacterial pathogens associated with paediatric sepsis and to determine their antibiotic susceptibility pattern. Material and Methods: A retrospective observational study was carried out by reviewing the records of blood cultures received from clinically suspected paediatric patients of septicaemia between January to December 2017 in the Department of Microbiology, G.M.E.R.S Medical College and Hospital Gotri, Vadodara, Gujarat. 713 samples of blood cultures were received and processed during that period. The isolates were identified by conventional biochemical tests. Antibiotic susceptibility testing was performed by Modified Kirby-Bauer disc diffusion method and the screened strains were further processed for detection of Extended Spectrum Beta Lactamases (ESBL) and Methicillin Resistant Staphylococcus aureus (MRSA) according to CLSI guidelines. Results: Out of the 713 Blood cultures, 161 (22.58%) were culture positive, of which 120 (74.54%) were Gram negative isolates and 41 (25.46%) were Gram positive. MRSA was detected in 38.46 % of the Staphylococcus aureus (S.aureus) isolates. 54% of Klebsiella spp and 52.63 % of Escherichia coli were found to be ESBL producers. Conclusion: High rates of isolation of MRSA and ESBL stresses on the need for a continued screening and surveillance for antibiotic resistance in Paediatric Care Units, which will influence the appropriate empiric treatment and infection control strategies for prevention of septicaemia in paediatric

Community-acquired Invasive Bacterial Disease in Urban Gambia, 2005-2015: A Hospital-based Surveillance.

Background. Invasive bacterial diseases cause significant disease and death in sub-Saharan Africa. Several are vaccine preventable, although the impact of new vaccines and vaccine policies on disease patterns in these communities is poorly understood owing to limited surveillance data. Methods. We conducted a hospital-based surveillance of invasive bacterial diseases in The Gambia where blood and cerebrospinal fluid (CSF) samples of hospitalized participants were processed. Three surveillance periods were defined in relation to the introduction of pneumococcal conjugate vaccines (PCVs), before (2005- 2009), during (2010–2011) and after (2012–2015) PCV introduction. We determined the prevalences of commonly isolated bacteria and compared them between the different surveillance periods. Results. A total of 14 715 blood and 1103 CSF samples were collected over 11 years; overall, 1045 clinically significant organisms were isolated from 957 patients (972 organisms [6.6%] from blood and 73 [6.6%] from CSF). The most common blood culture isolates were Streptococcus pneumoniae (24.9%), Staphylococcus aureus (22.0%), Escherichia coli (10.9%), and nontyphoidal Salmonella (10.0%). Between the pre-PCV and post-PCV eras, the prevalence of S. pneumoniae bacteremia dropped across all age groups (from 32.4% to 16.5%; odds ratio, 0.41; 95% confidence interval, .29–.58) while S. aureus increased in prevalence, becoming the most prevalent bacteria (from 16.9% to 27.2%; 1.75; 1.26–2.44). Overall, S. pneumoniae (53.4%), Neisseria meningitidis (13.7%), and Haemophilus influenzae (12.3%) were the predominant isolates from CSF. Antimicrobial resistance to common antibiotics was low. Conclusions. Our findings demonstrate that surveillance data on the predominant pathogens associated with invasive disease is necessary to inform vaccine priorities and appropriate management of patients.

Low incidence of Staphylococcus argenteus bacteremia in Hiroshima, Japan

Staphylococcus argenteus is a globally distributed cause of human infection; however, it has been misidentified as Staphylococcus aureus in diagnostic laboratories. Invasive infection caused by S. argenteus has been increasingly reported worldwide. However, there have been no reports on S. argenteus bacteremia in Japan. Therefore, we conducted a retrospective study to investigate the incidence of S. argenteus bacteremia at Hiroshima University Hospital between 2013 and 2017. S. argenteus was identified based on the absence of the crtM gene and multi-locus sequence typing. S. argenteus was identified in 2 of the 201 S. aureus blood culture isolates (1.0%). Both S. argenteus isolates belonged to sequence type 2250 harboring the staphylococcal enterotoxin Y gene (sey) and were susceptible to methicillin. One of them was penicillin-resistant, harboring a blaZ gene. The primary sites of infection were lower leg cellulitis and catheter-related blood stream infection. No patients died during hospitalization. This study suggested a low incidence of S. argenteus bacteremia in Japan when compared with reports from other countries. Further studies are necessary to investigate the prevalence of S. argenteus infection in Japan and the clinical impact of S. argenteus compared to S. aureus.

Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients.

The gastrointestinal tract is the predicted reservoir for most bloodstream infections (BSIs) after hematopoietic stem cell transplantation (HSCT). Whole-genome sequencing and comparative genomics have the potential to improve our understanding of the dynamics of gut colonization that precede BSI in HSCT recipients. Within a prospective cohort study of children (age <18 years) undergoing HSCT, 9 subjects met criteria for mucosal barrier injury BSI. We performed whole-genome sequencing of the blood culture isolate and weekly fecal samples preceding the BSI to compare the genetic similarity of BSI isolates to fecal strains. We evaluated temporal associations between antibiotic exposures and the abundances of BSI strains in the gut microbiota and correlated the detection of antibiotic resistance genes with the phenotypic antibiotic resistance of these strains. The median patient age was 2.6 years, and 78% were male. BSIs were caused by Escherichia coli (n = 5), Enterococcus faecium (n = 2), Enterobacter cloacae (n = 1), and Rothia mucilaginosa (n = 1). In the 6 BSI episodes with evaluable comparative genomics, the fecal strains were identical to the blood culture isolate (>99.99% genetic similarity). Gut domination by these strains preceded only 4 of 7 E. coli or E. faecium BSIs by a median of 17 days (range, 6 to 21 days). Increasing abundances of the resulting BSI strains in the gut microbiota were frequently associated with specific antibiotic exposures. E. cloacae and R. mucilaginosa were not highly abundant in fecal samples preceding BSIs caused by these species. The detection of antibiotic resistance genes for β-lactam antibiotics and vancomycin predicted phenotypic resistance in BSI strains. Bacterial strains causing mucosal barrier injury BSI in pediatric HSCT recipients were observed in the gut microbiota before BSI onset, and changes in the abundances of these strains within the gut preceded most BSI episodes. However, frequent sampling of the gut microbiota and sampling of other ecological niches is likely necessary to effectively predict BSI in HSCT recipients.

Chlorhexidine sensitivity in staphylococci isolated from patients with central line-associated bloodstream infection

Since 2011, 2% chlorhexidine in 70% isopropyl alcohol (2% chlorhexidine tincture) has been widely used in Korea. To investigate changes in chlorhexidine sensitivity of staphylococci causing central line-associated bloodstream infections, 264 blood culture isolates from adult patients treated in intensive care units of five university hospitals between 2008 and 2016 were analysed. We observed no significant changes in chlorhexidine minimum inhibitory and bactericidal concentrations, or in the prevalence of resistance-associated genes before and after introduction of 2% chlorhexidine tincture. Thus, there was no evidence of increased resistance to chlorhexidine in staphylococci causing central line-associated bloodstream infections.

Species distribution and antibiotic sensitivity pattern of coagulase negative staphylococci isolated from blood culture of NICU patients

Introduction : The study of blood cultures isolates was conducted on samples received from NICU of a tertiary care hospital at Ahmedabad during a period of two years. Objectives: To isolate, identify & find out prevalence of various species of coagulase negative staphylococci (CoNS) from blood culture of neonatal intensive care unit (NICU) patients. To study antibiotic susceptibility pattern of those isolates. Materials and Methods: Same staphylococcal species isolated multiple times from the each patient were considered true/probable pathogens and were considered for further analysis. Species characterization and antimicrobial sensitivity testing were done. The data was analyzed with WHONET 5.6 software. Results: Out of 4889 blood cultures received from NICU during the study period, 1465 samples were found positive (positivity rate of 30.0%). The most common CoNS species were S. epidermidis (64.6%) followed by S. haemolyticus and S. hominis. Septicemia by CoNS was more frequent in male & low birth weight groups. Isolates were least susceptible to penicillin-G (9.38%) while they were most susceptible to vancomycin (100%), teicoplanin (100%) and linezolid (100%). Methicillin resistance was found to be 26.04% among CoNS isolates. Conclusion: This study indicates importance of coagulase negative staphylococci isolated from NICU blood cultures and suggests that strategies to reduce such infections in neonates are needed urgently, to reduce their medical, social, and economic toll. Keywords: NICU, Neonatal intensive care unit, Antimicrobial sensitivity, CoNS, Coagulase negative staphylococci, Blood culture.

Antibiotic Susceptibility of Bloodstream Isolates in a Pediatric Oncology Population: The Case for Ongoing Unit-specific Surveillance.

Fever in a neutropenic oncology patient requires rapid initiation of effective empiric antibiotics to prevent mortality. We evaluated the appropriateness of our current empiric antibiotic regimen by assessing local antibiotic-susceptibility patterns in our pediatric oncology patients, and comparing them to the general pediatric patterns in our hospital. All blood culture isolates from pediatric oncology patients were reviewed over a 3-year period. Gram-negative and Gram-positive organisms were reviewed separately, with antibiotic susceptibilities for all unique isolates evaluated, and antibiograms generated and compared with general pediatric patients via the Fisher exact test. A total of 84% of Gram negatives were susceptible to meropenem; all resistant organisms were Pseudomonas aeruginosa, with 50% meropenem susceptibility. A total of 91% of Gram negatives were susceptible to cefepime, including 90% of P. aeruginosa and 80% of Escherichia coli. In total, 96% of Gram positives were vancomycin-susceptible; the only resistant organism was a single enterococcal isolate. In comparison with the general pediatric population, significantly fewer pseudomonal isolates were sensitive to meropenem among the oncology population (50% vs. 89%, P=0.0034). As such, in our population, meropenem does not provide adequate monotherapy against Pseudomonas. Ongoing surveillance of antibiotic resistance in this high-risk population is warranted, to ensure appropriate empiric antibiotic usage.

Association between antimicrobial resistance among Enterobacteriaceae and burden of environmental bacteria in hospital acquired infections: analysis of clinical studies and national reports

BackgroundWHO has named three groups of gram-negative bacteria “our critical antimicrobial resistance-related problems globally”. It is thus a priority to unveil any important covariation of variables behind this three-headed epidemic, which has gained alarming proportions in Low Income Countries, and spreads rapidly. Environmental bacteria including Acinetobacter spp. are common nosocomial pathogens in institutions that have high rates of antimicrobial resistance among other groups of gram-negative bacteria. MethodsBased on two different data sources, we calculated the correlation coefficient (Pearson's r) between pathogenic burden of Acinetobacter spp. and antimicrobial resistance among Enterobacteriaceae in European and African nosocomial cohorts. Clinical reportsDatabase search for studies on nosocomial sepsis in Europe and Africa was followed by a PRISMA-guided selection process. National reportsData from Point prevalence survey of healthcare-associated infections published by European Centre for Disease Prevention and Control were used to study the correlation between prevalence of Acinetobacter spp. and antimicrobial resistance among K. pneumoniae in blood culture isolates. FindingsThe two approaches both revealed a strong association between prevalence of Acinetobacter spp. and rates of resistance against 3. generation cephalosporins among Enterobacteriaceae. In the study of clinical reports (13 selected studies included), r was 0.96 (0.80–0.99) when calculated by proportions on log scale. Based on national reports, r was 0.80 (0.56–0.92) for the correlation between resistance rates of K. pneumoniae and proportion of Acinetobacter spp. InterpretationThe critical antimicrobial resistance-related epidemics that concern enteric and environmental gram-negative bacteria are not independent epidemics; they have a common promoting factor, or they are mutually supportive. Further, accumulation of antimicrobial resistance in nosocomial settings depends on the therapeutic environment. Burden of Acinetobacter spp. as defined here is a candidate measure for this dependence.

Emergence of Carbapenem-Resistant Acinetobacter baumannii ST195 Harboring blaOXA-23 Isolated from Bacteremia in Hong Kong.

Aims: The aim of the study was to analyze the epidemiology of Acinetobacter baumannii and investigate the genetic characteristics of carbapenem-resistant A. baumannii (CRAB) isolates isolated from blood cultures in a regional hospital in Hong Kong. Results: Twenty blood culture isolates were collected from a regional hospital in Hong Kong from 2014 to 2017. Twenty isolates were grouped into five existing sequence types (STs) and five new STs within the following prevalence: ST195 was predominant with a prevalence of 45% (n = 9), followed by ST373 and ST447 (10%; n = 2 each), and ST176 and ST345 (5%; n = 1 each). Resistance to carbapenem antibiotics was 55% (n = 11). Six carbapenem-resistant isolates harbored blaOXA-23 genes and ISAba1 mobile elements. Polymerase chain reaction confirmed that ISAba1 is located upstream to the blaOXA-23 genes, suggesting an association between ISAba1 and blaOXA-23 genes with carbapenem resistance. Conclusion: This study is the first to report the emergence of CRAB ST195 harboring blaOXA-23 in Hong Kong.

A retrospective evaluation: bacteriologic resistance profile of blood culture isolates in an intensive treatment unit (ITU) in a southeast Spanish hospital

A retrospective evaluation: bacteriologic resistance profile of blood culture isolates in an intensive treatment unit (ITU) in a southeast Spanish hospital

In vitro antimicrobial activity against Abiotrophia defectiva and Granulicatella elegans biofilms.

To determine the efficacy of different antibiotics (alone or in combination) against Abiotrophia defectiva and Granulicatella elegans biofilms and to investigate the anti-biofilm activity of gentamicin alone versus blood culture isolates from both species. The activity of benzylpenicillin, clindamycin, daptomycin, fosfomycin, gentamicin, levofloxacin and rifampicin against 24-hour-old biofilms of A. defectiva and G. elegans was investigated in vitro by conventional microbiological methods and isothermal microcalorimetry. For planktonic bacteria, the MIC values of tested antibiotics ranged from 0.016 to 64 mg/L, as determined by microcalorimetry. Higher antibiotic concentrations, ranging from 1 to >1024 mg/L, were needed to produce an effect on biofilm bacteria. Gentamicin was an exception as it was active at 1 mg/L against both planktonic and biofilm G. elegans. A synergistic effect was observed when daptomycin was combined with benzylpenicillin, gentamicin or rifampicin against A. defectiva biofilms and when gentamicin was combined with rifampicin or levofloxacin against G. elegans biofilms. A. defectiva clinical isolates displayed greater variability in gentamicin susceptibility as compared with G. elegans strains. Antimicrobial susceptibility profiles vary widely between Abiotrophia and Granulicatella biofilms, and synergistic effects of the tested antibiotics were heterogeneous. The clinical relevance of these in vitro observations needs to be confirmed in experimental in vivo conditions and human trials, before guidelines for the treatment of A. defectiva and G. elegans infections are established. This study suggests the benefit of further clinical exploration of antibiotic combinations with anti-biofilm effect.

Neonatal septicemia: Blood culture bacterial isolates and their antimicrobial susceptibility pattern

Abstract Introduction: Neonatal septicemia is defined as “a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first four weeks of life”. Blood culture is the gold standard method for diagnosis of septicemia. Isolation of organism in blood culture and its antimicrobial sensitivity pattern carries a great role. Aim: To provide prevalence and antimicrobial susceptibility pattern of bacteria isolated from suspected cases of neonatal septicemia at a tertiary care hospital, Valsad. Materials and Mathods: Retrospective study is conducted at a tertiary care hospital, Valsad from January 2017 to June 2018. Processing of blood culture samples, Isolation and identification of bacteria were done using standard microbiology techniques. Antimicrobial susceptibility testing was performed using modified Kirby-Bauer disk diffusion method as per Clinical laboratory Standard Institute guideline. ATCC E. coli 25922, ATCC S. aureus 25923, ATCC P. aeruginosa 27853 were used as standard strains. Results: Out of 452 blood cultures, organisms were isolated in 127(28.09%). Commonly isolated bacteria are Coagulase Negative Staphylococci (42.52%) followed by Klebsiella spp. (18.11%), Acinetobacter spp. (15.75%), Enterococcus spp. (9.45%) and others (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa). Coagulase Negative Staphylococci strains have highest sensitivity to Vancomycin (100%), Linezolid (100%), Teicoplanin (100%), followed by Chloramphenicol (92.6%), Levofloxacin (90.7%), Cefoxitin (83.3%), and Tetracycline (77.8%). 16.7% isolates were Methicillin Resistant Staphylococci (MRS). Klebsiella spp. strain have highest sensitivity to Meropenem (73.9%), Imipenem (73.9%) and Amikacin (69.6%) followed by Chloramphenicol (65.2%), Tetracycline (60.9%) and Piperacillin Tazobactum (52.2%). 78.3% strains were Extended spectrum Beta-Lactamase (ESBL) producers. Conclusion: Antimicrobial resistances are growing among bacteria an

Determination of Antimicrobial Resistance Patterns in Bloodstream Infections-Isolated Bacteria From a University Tertiary Hospital Patients

Background: Bloodstream infections are considered a significant medical concern associated with high morbidity and mortality rates. Therefore, physicians should be guided to use antimicrobial susceptibility patterns in order to select appropriate empiric antimicrobial agents to treat the patients who suffer from bacteremia. Objective: The present study aimed to determine antimicrobial resistance and susceptibility patterns in isolates collected from bloodstream infections. Materials and Methods: To achieve this, a total of 710 bacterial blood culture isolates were collected from Sina hospital, and then susceptibility patterns to a number of antibiotics were analyzed according to Clinical and Laboratory Standards Institute guidelines. Results: The identified isolates included Staphylococcus aureus 14 (20.6%), Escherichia coli 14 (20.6%), Acinetobacter baumannii 12 (17.6%), Pseudomonas aeruginosa 11 (16.2%), Coagulasenegative Staphylococcus 8 (11.8%), Klebsiella pneumoniae 6 (8.8%), and Enterobacter spp. 3 (4.4%). The total resistance rate to co-trimoxazole, ceftriaxone, ceftazidime, cefotaxime, ofloxacin, gentamicin, ciprofloxacin, levofloxacin, amikacin, and imipenem was 44 (64.7%), 42 (61.8%), 39 (57.4%), 38 (55.9%), 35 (51.51%), 32 (47.1%), 31 (45.6%), 25 (36.8%), and 27 (39.7%), respectively. Finally, the susceptibility rate to amikacin and imipenem was 43 (63.2%) and 41 (60.3%), respectively. Conclusion: In general, A. baumannii strains isolated from blood cultures were resistant to most antibiotics and the greatest sensitivity was observed to gentamicin (58.3%) compared to other antibiotics. Therefore, gentamicin was found as the most effective antibiotic for treating bloodstream infections caused by A. baumannii.

Early-Onset Neonatal Pneumococcal Infection

Abstract Streptococcus pneumoniae (SP) is a major cause of morbidity in childhood but has accounted for only a few reported cases of early-onset neonatal sepsis. Over the past decade, there have been increasing reports of early-onset neonatal sepsis due to SP associated with fulminant systemic disease and high mortality rates. Simultaneous maternal and neonatal sepsis with SP is relatively unusual. The literature reports rare cases of vaginal carriage and/or endometritis with this organism resulting in neonatal sepsis. We present a case of neonatal pneumococcal serotype 1 sepsis and cellulitis occurring concurrently with puerperal pneumococcal bacteremia. A male neonate was born at 38 weeks' gestation after a normal pregnancy. Although he was administered the appropriate antibiotics, the baby developed nape cellulitis and sepsis on the second day of life with SP that progressed to abscess formation requiring surgical drainage. The mother simultaneously developed pneumococcal bacteremia and endometritis 2 hours after delivery. Blood culture isolates from the mother and child were both serogroup 1. Transmission to the neonate may have been ascending or hematogenous. In addition, we summarize the neonate and maternal characteristics, clinical courses, and outcomes of published case reports of early-onset neonatal pneumococcal sepsis in the peer-reviewed literature. Our case highlights the need to consider SP as a cause of neonatal sepsis that can mimic early-onset group B streptococcal infection. Recognition of resistant strains in cases of bacteremia and meningitis is critical, and should be considered in choice of antibiotic therapy. Enhanced surveillance for the maternal carriage of SP and invasive pneumococcal disease during the neonatal period would help to define the epidemiology.

Neonatal sepsis in a tertiary care hospital in Delhi, India: study of microbial profile and antimicrobial susceptibility pattern

Background: Sepsis is one of the most common cause of neonatal deaths globally more so in low and middle-income countries. The key to management is high degree of clinical suspicion and prompt initiation of empirical antibiotic therapy pending investigations’ results. Knowledge of one’s own NICU flora and antimicrobial susceptibility pattern guides in choosing correct antibiotic therapy to pediatrician. If this data is standard and comparable across different sites, then it also helps in formulating regional and National treatment guidelines. Present study was therefore undertaken to study microbial flora of present NICU and analyze their antimicrobial susceptibility pattern and formulate antimicrobial policy.Methods: Data of blood culture isolates sent from suspected cases of neonatal sepsis received from January 2017 to July 2018 was analysed by “WHONET”.Results: One hundred ninety-three non-repeat isolates were obtained from 992 blood culture samples. Coagulase negative Staphylococcus and K. pneumoniae were the most common isolates. Non albicans Candida were responsible for majority of fungal infection. There was an outbreak of C. pelliculosa for six months. Most of the bacteria were multidrug resistant (MDR). However, except one all other Candida isolates were sensitive to antifungal drugs.Conclusions: WHO guidelines suggest use of penicillin and gentamicin for neonatal sepsis. But in present study, they were not found useful, instead amikacin, netilmicin and piperacillin-tazobactam were found useful and changes were made in antibiotic policy. Authors therefore recommend regular monitoring of antimicrobial susceptibility pattern followed by necessary changes in antibiotic policy for reasonable empirical therapy.