Blood Culture Reports Research Articles

Comparative study of micro ESR with CRP and blood culture sensitivity

Background: Neonatal sepsis is one of the leading causes of morbidity and mortality among neonates in India. Indian association of paediatrics has developed sepsis screen which is useful for early diagnosis. To test the reliability of micro ESR as bedside tool in early diagnosis of neonatal sepsis we conducted this study. Comparison of Micro-erythrocyte sedimentation rate (micro ESR) with C-reactive protein (CRP) and blood culture sensitivity in neonatal sepsis. To establish a relation between severity of sepsis and Micro-erythrocyte sedimentation rate. Methods: This is a cross sectional study done at neonatal intensive care unit (NICU), at our institute over a period of six months. Fifty neonates with risk factors for sepsis and who had a positive sepsis screen were enrolled prospectively into the study. Results: Out of 50 samples collected, micro ESR (>15 mm/hour) was positive in 12 cases (24%) and CRP was positive in 18 cases (36%). After procuring the blood culture report, 48 cases had neonatal sepsis (84%). Our study showed that micro-ESR as a bedside test had a positive correlation with mortality (p value <0.001) when compared with CRP values (p value=0.546) in neonatal sepsis. As expected, elevated micro ESR and high CRP value had 100% correlation but was not statistically significant (p=0.319). In all the 12 cases with raised micro ESR had 100% blood culture positivity but significance could not be established. Conclusions: Micro-ESR had a significant correlation with mortality in neonatal sepsis.

Demographic Study on Enteric Fever: A Single Centre Experiences

Background: Typhoid fever, caused by Salmonella typhi and Salmonella paratyphi, infects various organs after entering the bloodstream. It typically presents with headache, fever, splenomegaly, abdominal pain, and leucopenia, among other symptoms. Globally, it affects 11-21 million people annually, causing 120,000-160,000 deaths, with Southeast Asia being the most impacted region. Improved water, sanitation, and hygiene (WASH) practices are crucial for prevention, alongside targeted public health strategies in endemic regions like Bangladesh. Aim of the study: The study aims to identify demographic risk factors associated with typhoid fever in Bangladesh. Methods: This cross-sectional observational study was conducted at the Department of Medicine, North Bengal Medical College Hospital, Sirajganj, Bangladesh, over 12 months. We included 72 patients presenting with fever, headache, and abdominal pain, with positive blood culture reports for Salmonella typhi and Salmonella paratyphi, aged 18 years and above, who provided informed consent. Excluded were patients on antibiotics and those with multiple blood culture samples. A short questionnaire, validated through a pilot study, captured demographic and clinical data. Result: Mostly 76.39% of participants were aged 18-45. Males comprised 58.33% of participants, and females 41.67%. Occupationally, 48.61% were civil servants, 16.67% housewives, 13.89% students, 12.50% businessmen, and 8.33% farmers. Socio-economically, 16.67% were upper class, 37.50% middle class, and 45.83% lower class. Urban residents made up 40.28% and rural residents 59.72%. All participants had a fever, with other symptoms including headache (69.44%), abdominal pain (48.61%), vomiting (20.83%), coated tongue (27.78%), and constipation (61.11%). Conclusion: This study examines factors influencing enteric fever in Bangladesh, noting higher prevalence among males aged 18-45 due to occupational risks. Lower socio-economic status and rural living also increase risk, highlighting healthcare disparities. Common symptoms included fever, headache, and abdominal pain. Improving sanitation and targeting high-risk groups can reduce incidence.

An Observational Study on C-Reactive Protein to Platelet Ratio in Neonatal Sepsis.

Neonatal sepsis is a serious medical condition affecting many individuals in the developing world. C-reactive protein (CRP) level in serum and platelet counts have been reported to have role in diagnosis of neonatal sepsis. To evaluate the CRP to Platelet ratio (CPR) in relation to time and blood culture reports in neonatal sepsis patients from a tertiary care centre in the Marathwada region of Maharashtra. The present observational study was conducted at the level III Neonatal Intensive Care Unit of a tertiary care centre in Aurangabad city of Marathwada region in Maharashtra from September 2022 to July 2023. The study included 120 neonates (delivered after completion of 28-42 weeks of gestation) with clinical/culture-positive sepsis. The newborns of seropositive mothers, neonates delivered in other hospitals, babies with congenital dysmorphic features, and babies requiring surgical procedures were excluded from the study. Blood samples for complete blood count (CBC) and CRP were collected on days 1, 3 and 5. Blood cultures were sent on day 1 of illness. Repeated measures ANOVA was used to compare the parameters of CPR, CRP, and platelet count in blood culture-positive and blood culture-negative neonatal sepsis patients on days 1, 3 and 5. Blood culture was positive in 37 (30.8%) cases. A repeated measures ANOVA showed a significant overall difference in the CPR across days 1, 3, and 5 (p = 0.006). The CPR was significantly higher in culture-positive neonates compared to culture-negative neonates (p = 0.042). Higher CPR in blood culture-positive neonates compared to blood culture-negative neonates supports the role of CPR in the diagnosis and management of neonatal sepsis.

Brucella anthropi infection in a 5-week-old infant

Congenital brucellosis in infants is well described but occurs rarely and very few cases have been reported till now. Acquired brucellosis in young infants has rarely been reported. A 5-week-old infant weighing 3340 gm, presented to the emergency with complaints of fever, abdominal distension, lethargy, and decreased feeding for five days. A clinical diagnosis of septicemia was made. Laboratory parameters were suggestive of septicemia. There was a history of ingestion of unpasteurized buffalo’s milk. Empirical antibiotics started after withdrawing the blood culture. Blood culture came positive for Brucella anthropi. Ultrasonography of the abdomen showed a small abscess in the left iliac fossa measuring 44×38 mm. The antibiotics were changed to piperacillin-tazobactam and amikacin as per the blood culture and sensitivity report. Supportive care was given, and the baby gradually improved. The child was discharged on oral rifampicin and trimethoprim-sulfamethoxazole for 4 weeks and is being followed up and is doing well. Young infants may acquire Brucella infection from breastmilk or ingesting unpasteurized animal milk. Prompt diagnosis and treatment is the key to management. Exclusive breastfeeding is the best way to prevent not only animal milk-acquired Brucella but most other types of infection.

IJCM_120A: Factors associated with neonatal sepsis in tertiary care hospitals of Mangalore: A retrospective study

Background: Neonatal sepsis remains a significant cause of morbidity and mortality globally, particularly in developing countries like India. Early and late onset sepsis present unique challenges in diagnosis and management, with maternal and neonatal factors playing crucial roles in the manifestation of the condition. Methodology: Data were collected from tertiary care hospitals affiliated with Kasturba Medical College, Mangaluru. A structured proforma was used to gather information on maternal factors, birth history, neonatal conditions, and complications. Statistical analysis was performed using Chi- square test and student’s ‘t’ test. Results: Out of 132 cases, 50.75% were early onset sepsis (EOS) and 49.25% were late onset sepsis (LOS). Blood culture reports were positive in 46.1% cases. Maternal comorbidities included gestational diabetes mellitus (GDM), antepartum hemorrhage (APH), and pregnancy-induced hypertension (PIH). Neonatal comorbidities such as convulsions, congenital malformations, neonatal jaundice, preterm birth, and low birth weight were observed. Positive blood culture reports correlated with low birth weight and preterm births. Staphylococcus aureus was the most common organism, followed by Citrobacter Spp., Enterobacter Spp., and Pseudomonas aeruginosa. Sensitivity analysis revealed varying degrees of susceptibility to different antibiotics. Conclusion: Maternal factors like GDM, APH, and PIH showed no significant correlation with neonatal sepsis, whereas neonatal factors such as low birth weight and preterm birth were associated with an increased risk. Consanguinity also emerged as a potential risk factor. Staphylococcus aureus was the predominant causative organism, with varying antibiotic sensitivities. This study underscores the importance of understanding maternal and neonatal factors in the prevention and management of neonatal sepsis.

Epidemiology of Febrile Neutropenic and Bacteremic Patients in the Extensively Drug-Resistant Era

Background: Appropriate empiric antibiotic use is of utmost importance in febrile neutropenic patients. This study analyzed positive blood culture reports from febrile neutropenic patients and provided a new empirical antibiotic treatment approach. Methods: This study retrospectively enrolled febrile neutropenic patients with hematological or solid organ malignancies who had positive blood cultures at the Bahrain Oncology Center within January 2019 to August 2021. Microbiological data were used to draw inferences for rational antimicrobial treatment. The quick sequential organ failure assessment (qSOFA) score was employed to classify the severity status. The t-test was used to compare univariate and multivariate sensitivity values for two dependent proportions. Results: A total of 73 episodes of bacteremia were detected in 53 patients. Among these, 54 episodes (74%) were caused by gram-negative organisms. The most commonly isolated organisms were Escherichia coli (30%), Klebsiella pneumonia (22%), and coagulase-negative staphylococci (11%). The rate of extensively drug-resistant strains among K. pneumoniae was 44% (n = 7). Among gram-negative microorganisms, the susceptibility rates for monotherapies were reported for ceftazidime (56%), piperacillin/tazobactam (76%), cefepime (54%), meropenem (80%), and ceftazidime-avibactam (91%). The susceptibility rates for tigecycline-based combinations exceeded 90% overall. Conclusions: Clinical severity and local epidemiological data should be considered in the management of febrile neutropenia. New antibiotics and tigecycline should be considered for combination therapy in selected cases due to the increasing resistance observed.

Frequency of microorganisms in children presenting with acute fever at the outpatient department.

Objective: To determine the incidence of blood stream bacterial infection and the frequency of microorganisms involved as evaluated by blood culture in children presenting with acute febrile illness at the outpatient department. Study Design: Cross-sectional study. Setting: Department of Pediatrics and Child Health, Mardan Medical Complex, Mardan, Pakistan. Period: 1st March 2023 to 31st of August 2023. Material & Methods: A total of 252 children from both genders between the ages of 1 month to 15 years presented at outpatients department with fever (≥ 38.0 °C or 100.4 °F) for ˃ two days were included in the study using consecutive sampling technique. The blood cultures of these children were sent to the laboratory for investigations. Bacterial strains were isolated and identified using standard microbiological techniques. The primary outcome was to determine the incidence of blood stream bacterial infection and the frequency of microorganisms involved. Results: The Mean±SD of age is this study was 4.20±3.42 years with an age range of 0.5-14 years. Male gender was 51.59% while female gender was 48.41%. The results of blood culture report showed that bacterial growth was present in 37 (14.68%) of total study patients. Out of these positive blood cultures, Gram-positive Cocci was reported in 16 (43.24%) of the children while Gram-negative bacilli were present in 21 (56.76%). The prevalence of E Coli was highest in these children 10 (27.02%) followed by S Typhi 8 (21.62%), Streptococcus pneumonia 5 (13.51%) and S aureus 4 (10.81%). Conclusion: It was concluded that the Gram-negative bacilli are the common cause of bacterial infection in children presenting with fever at outpatient department of a tertiary care hospital in this region with most frequent presence of E Coli and S Typhi.

Group B Streptococcal Septicaemia Causing Bilateral Acute Parotitis in an Infant: A Rare Case Report

Acute parotitis is a rare condition in young infants and is characterized by swelling of the parotid gland associated with fever and pain. Staphylococcus aureus is the most common causative agent of this disease. Prevalence is higher in males. We describe the case of a 55-day-old Asian female infant who presented in the emergency department with complaints of fever, reluctance to feed, and irritability with unremarkable examination. During hospitalization pre-auricular edema was observed bilaterally close to the angle of the jaw along with signs of inflammation, greater on the right side. Ultrasound findings showed parotid gland enlargement and blood culture report was positive for Streptococcus pyogenes. Antibiotic treatment with injectable Vancomycin was given for 7 days and the patient had rapid recovery in terms of both symptom improvement and reduction of glandular swelling. This case illustrates the need for consideration of this disease in infants and its likelihood in both genders and emphasizes the early institution of appropriate therapy of acute parotitis for faster recovery and prevention of complications. There is much data on acute parotitis in adolescents but due to the paucity of data in young infants, there is a need to investigate further the causes and treatment of this disease in infants.

Early Diagnosis of Neonatal Sepsis Using the Leukocyte Alkaline Phosphatase Score: A Cohort Study

Introduction: The clinical features of sepsis in neonates are subtle and non specific, requiring a high index of suspicion for early diagnosis. Blood culture is the gold standard for diagnosis, but it is time consuming. Therefore, there is a need for a costeffective and reliable screening tool. The Leukocyte Alkaline Phosphatase (LAP) activity of neutrophils is known to increase during bacterial infections in adults. Aim: To determine the activity of LAP in Neonatal Sepsis (NS) and compare the results with blood culture. Materials and Methods: This is a prospective cohort study conducted from January 2018 to June 2019 at Mandya Institute of Medical Sciences, Karnataka, India. Total of 200 neonates by their haematological profile were clinically suspected of having sepsis. A peripheral smear was prepared from a drop of blood and stained to assess the LAP activity. In each smear, a total of 100 consecutive segmented neutrophils were examined and were rated from 0 to 4 according to the red granular precipitate intensity within their cytoplasm. The possible range of 0-400. The blood culture report was obtained from the case sheet. The neonates were divided into two groups: Group 1 consisted of culture-proven sepsis cases, and Group 2 consisted of neonates with clinical suspicion of sepsis but negative blood culture results. Descriptive analysis was performed using mean and standard deviation for quantitative variables, and frequency and proportion for categorical variables. Chi-square test was conducted, and a p-value <0.05 was considered statistically significant. Results: Out of the 200 cases studied, 64 neonates showed a positive blood culture. The most common causative organism observed was Klebsiella pneumoniae, which was seen in 56 neonates. The age of the neonates ranged from newborn to 28 days old, with 115 being male. Furthermore, 116 neonates were term neonates, and 146 presented with early onset sepsis. The study revealed a wide range of LAP activity in both groups. In the culture-positive sepsis group, the LAP activity ranged from 36 to 350, while in the clinical sepsis group, it ranged from 10 to 354. Due to the broad range of LAP scores observed, it is concluded that LAP activity is not useful as a screening test. Conclusion: Findings of the present study indicate that LAP activity exhibited a wide range in both the culture-proven and clinical sepsis groups. However, due to this variability, LAP activity does not appear to be a reliable screening test for NS. While LAP activity assessment may still hold diagnostic value, further research is needed to refine its utility and explore its clinical relevance.

Diagnostic Yield of Blood Cultures among Patients Admitted with Non-Focal Pyrexias

OBJECTIVES To establish the diagnostic yield of blood cultures among patients admitted with non-focal pyrexias. METHODOLOGY This descriptive cross-sectional study was conducted in the Department of Medicine, Khyber Teaching Hospital, Peshawar, from August 2020 to April 2021. One hundred ninety-seven patients with non-focal pyrexia were recruited. Data about age, gender, presence of other illnesses like diabetes and hypertension, history of smoking and duration of fever were noted. A thorough clinical evaluation was done. Under aseptic conditions, 2 blood culture sets were taken. The final blood culture report was collected after 5 days of incubation in culture media. The culture was labelled positive if any organism was isolated from the sample. All data was entered in specially designed proforma. Patients with positive blood cultures were managed as per hospital protocols. Confidentiality of data was ensured. RESULTSOur study shows that among 197 patients, 18(9%) had positive cultures, while 179(91%) did not yield any pathogen on blood culture. Escherichia coli was the most commonly grown organism among the positive blood cultures. CONCLUSION The yield of blood culture was 9% in febrile patients admitted to the medical ward of a tertiary care hospital.

Analysis of Blood Cultures of Patients Presenting to the Emergency Department in a Tertiary Healthcare Hospital in Mumbai

Aim and objectives: Analysis of blood cultures taken from patients attending emergency departments is an important exercise in determining the common pathogens prevalent in the region. The distribution of these infective pathogens keeps changing over time, and the rise in antimicrobial-resistant pathogens makes it difficult to routinely conduct effective empirical broad-spectrum antimicrobial therapy. This study aimed to analyse the results of blood cultures obtained from patients presenting to the Emergency Department of a Tertiary Healthcare Hospital in Mumbai and provide updated and detailed information on the distribution of causative pathogens in adult sepsis and study their antibiotic-susceptibility pattern. Materials and methods: A hospital-based prospective cross-sectional study of 121 positive blood culture reports was conducted at the Department of Emergency Medicine, Fortis Hospital Mulund, Mumbai, which included all adult (age > 18 yrs) suspected sepsis patients arriving to the Emergency Department whose blood cultures were sent from the Emergency Department from January 2021 to December 2021. Results: The study showed that mean age of the study cases was 59.3 years with 59.5% cases that belonged to the elderly age group with a male predominance (56.2% males–43.8% females). Overall, Gram-negative isolates were seen in 95% cases, while Gram-positive isolates were seen in only 1.7% cases. The most common organism isolated from cases with sepsis was Escherichia coli (45.5%) followed by Klebsiella (13.2%), Salmonella (10.7%), Stenotrophomonas (7.4%) and Pseudomonas (5%). Among Gram-positive organisms, Staphylococcus aureus was the most common organism isolated (1.7%). Escherichia coli isolates showed poor sensitivity towards fluoroquinolones and cephalosporins while good sensitivity towards aminoglycosides, carbapenems and combination drugs like Cefoperazone and Sulbactam and Piperacillin and Tazobactam. These findings suggest that Gram-negative organisms are the most common isolates observed in this study, with E. coli being the predominant pathogen followed by Klebsiella. High-level antimicrobial resistance was observed in sepsis cases for commonly used antimicrobials like fluoroquinolones and cephalosporins.

Assessing the diagnostic potential of 16SrRNA gene for neonatal sepsis: A tertiary care hospital study in South India

BackgroundThe need of the hour is to incorporate a rapid assay that could efficiently detect neonatal sepsis. We evaluated the diagnostic utility of 16SrRNA broad-range polymerase chain reaction (PCR) in neonatal sepsis. MethodsThe demographic and clinical details of 100 neonates clinically suspected to have sepsis were collected adopting pretested clinical proforma, followed by baseline laboratory investigations, including blood culture, complete blood counts, and C-reactive protein (CRP). Around, 0.2–0.3 ml of the EDTA blood was subjected to enrichment followed by DNA isolation using the modified spin column method. Based on the blood culture report, neonates were further divided into the suspected sepsis group (n = 50) and the confirmed sepsis group (n = 50). We performed 16SrRNA broad-range PCR to identify the presence of bacteria, and the results were analyzed statistically using SPSS software. ResultsNeonates in both groups were found to have clinical parameters comparable to each other except for birth weight, length, and head circumference, which was found to be lower in the culture-positive group than in culture-negative group (p < 0.05). The diagnosis of neonatal sepsis by 16SrRNA broad-range PCR compared to blood culture revealed 100% sensitivity, 64% specificity, and 73.5% positive and 100% negative predictive value. The 18 cases detected positive by PCR had clinical and other diagnostic findings consistent with sepsis. ConclusionThe 16SrRNA broad-range PCR effectively ruled out sepsis in 32 neonates within 8 h of sample collection compared to blood culture, which took 24 h. The method may not replace blood culture but can be used to complement it.

Antimicrobial sensitivity of salmonella typhi in children- A single center study.

Objective: To determine the frequency of antibiotic sensitivity of Salmonella typhi in children. Study Design: Prospective Cross Sectional Study. Setting: Department of Pediatrics, Children B Unit, Hayatabad Medical Complex, Peshawar. Period: 1st April 2021 to 30th June 2022. Material &amp; Methods: Pediatric patients admitted to Children B Unit, with blood culture proven enteric fever, were selected for the study. Verbal consent was obtained from the parents. Data was collected from blood culture report forms from microbiology laboratory of our hospital. Results were recorded on excel spreadsheet and analyzed for calculating percentages using MS Excel 2010. Results were presented in table 1. Results: This study was conducted on 32 female and 72 male children with blood culture proven enteric fever caused by Salmonella typhi. Sensitivity to Azithromycin was 56.73%, Meropenem 82.69%, Polymixin 86.53%, Colistin 68.26%, Ciprofloxacin 45.19%, Tigecycline98.07%, Imipenem 95.19%, Amikacin 90.38% and Gentamicin 77.88%. Conclusion: Salmonella typhi shows decreasing level of sensitivity to most antibiotics.

Incidence of Central Line-Associated Bloodstream Infection in a Tertiary Care Hospital in Northern India: A Prospective Study.

Background Central line-associated bloodstream infection is the most common hospital-acquired infection and is associated with high morbidity and mortality along with increased healthcare cost.However, studies on the incidence of nosocomial infections are very limited in India. Aims To determine the incidence of central line-associate bloodstream infection (CLABSI), microorganisms associated and their antimicrobial sensitivity profile in the medicalICU of a tertiary care hospital. Material and methods A total of 186patients who were admitted to the medical ICU and had a non-tunneled central venous catheter (CVC) implanted at admission in the emergency department or in the medical ICU for longer than 48 hours were monitored. By examining the blood culture reports, the patients were monitored every day for the emergence of new-onset sepsis after 48 hours following CVC insertion. The data were evaluated statistically using Microsoft Excel and SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Result Out of 186 catheterized patients, 37 developed CLABSI. The incidence of CLABSI was 9.3 per 1000 catheter days and 6.7 per 1000 inpatient days with a 0.7 device utilization ratio. The most common organism isolated was Acinetobacter species (22%) followed by K. pneumoniae (16%) and E. aerogenes(16%). The highest sensitivity was displayed by polymyxin B (100%) followed by tigecycline (85.48%) and minocycline (50.82%) in Gram-negative organisms. In Gram-positive organisms, the highest sensitivity was observed in S. aureus(100%) for vancomycin, linezolid and teicoplanin whereas Enterococcus species showed linezolid (100%) followed by vancomycin (93.75%) and teicoplanin (93.75%). Conclusion The prevention ofCLABSI requires knowledge of the infection rates and of the sources, the pathogens involved as well as their antimicrobial profile. Due to risingantimicrobial resistance, surveillance programs are crucial in establishing the species distribution and resistance patterns of bacteria causing BSIsand thus providing the basis for appropriate empirical therapy.

Human Brucellosis: An Observational Study From a Tertiary Care Centre in North India.

The main aim/objective of this study was to detect and characterize theBrucella speciesfrompatients having complaints of joint pain and also to know thepotential causes of human brucellosis. In our study, we focused on joint pain symptoms that may be due to arthralgia or arthritis. Introduction: Brucellosis is a neglected zoonotic disease that affects both humans and animals.In humans, brucellosis begins with chronic illness leading to greatfinanciallosses fromnot being able to work welland continued treatment costs, butfew such studies have come from northern India.Joint pain is the common presentation of brucellosis and there are several risk factors associated with brucellosis. A total of 200 blood samples were collected from the participants having joints pain from September 2019 to September 2021 at Gandhi Memorial & Associated Hospitals ofKing George's Medical University, Lucknow, India, and tested by serology for anti-BrucellaIgM and IgG enzyme-linked immunosorbent assay (ELISA),moleculartests byreverse transcriptase-polymerase chain reaction (RT-PCR),conventional polymerase chain reaction (PCR), and automated blood culture system.The anti-Brucella IgM and IgG ELISA were performed using the kit from NovaTec Immundiagnostica GmbH (Dietzenbach, Germany). Isolation of DNAwas carried out using the QIAamp DNA Mini kit (QIAGEN,Hilden, Germany), and the primers and probes specific for targeted regions (BCSP31 and IS711 gene)in theBrucellagenome were procured from Eurofins Scientific SE (Luxembourg, France), and for internal control from CDC. The study showed 19(9.5%) and 23 (11.5%) positive results by anti-BrucellaIgM ELISA and anti-BrucellaIgG, respectively, andof these, one (0.5%) was positive for both anti-BrucellaIgM and anti-BrucellaIgG ELISA.Out of 19 anti-Brucella IgM ELISA positive, eight (4%) samples were positive forPCR/RT-PCRandthat was negative for anti-Brucella IgG ELISA. All blood culture reports of all patients were negative. Conclusion: Anti-Brucella IgM ELISA was more accurate than anti-Brucella IgG ELISA in detecting human brucellosis. Consumption of animal products(i.e. milk, a dairy product of cow, buffalo, goat, and meat of goat)and contact with animals were themain risk factors that were identifiedfor Brucelladisease.

A prospective study evaluating the effect of a ‘Diagnostic Stewardship Care-Bundle’ for automated blood culture diagnostics

We prospectively implemented a diagnostic stewardship care-bundle checklist, 'Sepsis-48 DSB', with the aim of reducing intervening duration of key steps of automated blood culture diagnostics (aBCD). Sepsis-48 DSB was implemented for automated blood culture bottles (BCBs) received from adult intensive care units (AICUs) during the intervention period (P2; July 2020-June 2021) and intervening durations were compared with those during the retrospective, pre-intervention period (P1; March-June 2020). During both periods, provisional blood culture reports (pBCR) were issued wherein direct microbial identification (dID) was performed in BCBs with Gram-negatives by directly inoculating conventional biochemical tests and direct antimicrobial susceptibility testing (dAST) using EUCAST RAST method. The results were compared with the standard of care (SoC) method (i.e. full incubation followed by identification and AST by VITEKⓇ-2 Compact). During P2, significant reductions in loading time (LT) [median: 63.5 vs. 32 minutes, P < 0.001], time to dID+dAST performance (TTD) [186 vs. 115 minutes, P=0.0018] and an increase in compliance to bundle targets [LT ≤45: 44% vs. 66%, P=0.006 and TTD ≤120: 34% vs. 51.7%, P=0.03] were observed. Using dID+dAST method, results were read 694 minutes earlier than SoC method. Of 176 pBCR, 165 (94%) were concordant with SoC in microbial identification of species. Categorical agreement for any drug-bug combination was 92.7% (1079/1164) and corresponding major, very major, and minor error rates were 8.8% (19/216), 4.9% (45/921), and 1.8% (21/1164), respectively. The 'diagnostic stewardship care-bundle' strategy was successfully implemented with considerable diagnostic accuracy leading to significant reductions in duration of targeted steps of aBCD.

Seroprevalence of Brucellosis in Patients Having Complained of Joint Pain: A Case Control.

Brucellosis is a neglected zoonotic disease affecting humans and animals. This study aimed to estimate the seroprevalence of brucellosis in patients with joint pain. A total of 200 participants aged from 7 to 86 years were involved in this study. Blood samples were collected from all the participants for two years, from September 2019 to September 2021, and screened forBrucellausing anti-brucella IgM ELISA and anti-brucella IgG ELISA antibodies. A questionnaire was used to collect data on socio-demographic characteristics and human brucellosis-related risk factors. HumanBrucellaseroprevalence was 19 (9.5%) for BrucellaIgM ELISA and 23 (11.5%) forBrucellaIgG ELISA. The sensitivity forBrucellaIgM ELISA andBrucellaIgG ELISA was 65.2% and 31.6%, respectively, while the specificity was 44.1% forBrucellaIgM ELISA and 77.9% forBrucellaIgG ELISA. All blood culture reports of all patients were negative. The principal presentation was the observable symptoms of human brucellosis: fever, headache, chills, myalgia, and Joint pain. Risk factors like consumption of raw milk or their products were found to be the most important forBrucellainfection, so the awareness or information of risk factors and the modes of transmission is much more important in control and prevention programs. General awareness about clinical symptoms should be increased, which will improve proper diagnosis and will be helpful in early treatment. An ELISA test should be considered for diagnosing brucellosis in both acute and chronic phases.

Frequency of Thrombocytopenia and Associated Mortality in Neonates with Neonatal Sepsis

Aim: To assess the frequency of thrombocytopenia and associated mortality in neonates with neonatal sepsis. Methodology: This descriptive study was designed to identify the frequency of thrombocytopenia in neonates and conducted at Nazir Hussain Medical Complex KKF Hospital Hyderabad from 1st September 2022 to 28th February 2023 after ethical clearance through the institutional review committee. This study enrolled 190 neonates which were admitted in NICU with the diagnosis of neonatal sepsis. All those neonates under 28 days of age and having a positive blood culture reports were included. A 3cc whole blood was drawn from each neonate by a nursing staff in a single pick and blood test including haematological markers (haemoglobin, platelet count) and infection markers (white blood cells, neutrophil%, Lymphocyte%, C-reactive proteins and Erythrocyte sedimentation rate) were analyzed. Results: There were 60% male neonates while rest 40% were females. About 44.78% had a weight between 2.5-3.5kg. The mean platelet count was 182.95±156 x109/L whereas lymphocytes% mean value was 41.81±11.0% with a very high ESR reported as 21.08±14.2mm/hour. The frequency of thrombocytopenia was observed in 129(67.89%) neonates wherein it was observed as severe in 35(18.4%) neonates and the frequency of mortality was observed as fourfold increased in the cases of thrombocytopenia. Practical Implication: Factors like age, low birth weight, platelet count and severity of thrombocytopenia are related with outcomes of neonatal sepsis among neonates. Conclusion: There is a high frequency of thrombocytopenia within the cases of neonatal sepsis. The mortality is higher in cases with severe thrombocytopenia. Keywords: Frequency, Thrombocytopenia, Associated mortality, neonate, neonatal sepsis

Antimicrobial Sensitivity of Salmonella Species in Children - A Single-Centered Study

Background: Salmonellae are gram-negative, facultative anaerobic bacteria. Typhoid fever has a non-specific and varied appearance in its early stages. A high-grade fever (&gt;38oC) is the most common presenting sign. Salmonella pathogenicity is primarily determined bythe virulence components it possesses, such as Salmonella pathogenicity islands (SPIs), virulence plasmids, pili, and enterotoxins.The most common drug used was cefixime (66.6%), then ciprofloxacin, and according to a comparable study conducted in Pakistan (33.3%). Cefixime and ceftriaxone had a sensitivity of 60.9% and 65.8%, respectively. In 50.1% of S.typhi isolates, ciprofloxacin sensitivity was observed. Aim: To determine the frequency of the most common salmonella specie and its drug sensitivity in children. Methodology:This descriptive study was conducted in the Department of Pediatrics Bacha Khan Medical Complex Swabi from April 2022 to October 2022 in children with suspected enteric fever. Blood culture reports of suspected patients were sent to the laboratory and reports were followed, before reports arrived patients were started on antibiotics. The sensitivity of drugs was measured by calculating frequency and percentages. Results: This study was conducted on 63 children having blood culture reports presented to us with suspected enteric fever including 25 females and 38 males with a mean age of 6.4±27 years. The most common organism in the blood culture of children presented with enteric fever was salmonella typhi (95.2%). Salmonella paratyphoid species shows 100% sensitivity to co-triaxle, co-trimoxazole and amikacin while 50.8% to azithromycin. Salmonella paratyphi A with 100% sensitivity to amikacin, ampicillin, azithromycin, cefepime, cefoperazone, cefotaxime, co-amoxiclav and colistin. While salmonella typhi were found to be 95.2% with drugs sensitivity amikacin, colistin, fosfomycin, co-trimoxazole, and ertapenem (100%) and ciprofloxacin (73%). Practical implication: by knowing the most common organism and its drug’s sensitivity and resistance, the resistance to antibiotics will be reduced, and targeted antibiotics will be used. Conclusion: Salmonella typhiwas the most common pathogen detected in blood culture (95.2%) with 100%drug sensitivity to amikacin, colistin, fosfomycin, co-trimoxazole, and ertapenem. Keywords: Salmonellatyphi, sensitivity, blood culture, children, enteric fever

An 11-Year Review of Lactobacillus Bacteremia at a Pediatric Tertiary Care Center.

To inform clinical decisions on the use of probiotics in a pediatric inpatient setting, we sought to determine the number of cases of Lactobacillus bacteremia as well as associated patient characteristics in a tertiary-care pediatric hospital over an 11-year period. Cases of Lactobacillus bacteremia among admitted patients were identified through positive blood culture reports. The clinical chart for each case was reviewed for presenting symptoms and risk factors such as probiotic use, presence of a central venous catheter, immunocompromised state, impaired intestinal function, and age below 3 months. Concurrent total inpatient probiotic administration was assessed. Over an 11-year period, 8 cases of Lactobacillus bacteremia were identified among 127 845 hospital admissions. All cases were associated with systemic signs of infection. Lactobacillus bacteremia patients most frequently had underlying impaired intestinal function and a central venous catheter. Three cases had a history of probiotic use. The peak number of annual cases did not coincide with the peak number of inpatients who received probiotics. Lactobacillus bacteremia is uncommon and did not correlate with doses of probiotics-administered in the hospital. However, certain populations may be at higher risk and require extra consideration in clinical decision-making regarding use of probiotics.