SPECTRUM OF COMMUNITY ACQUIRED BLOOD STREAM INFECTION (CABSI) AND HOSPITAL ACQUIRED BLOOD STREAM INFECTION (HABSI) IN PATIENTS ADMITTED AT SKIMS; A PROSPECTIVE STUDY OF ETIO-PATHOGENESIS AND OUTCOME IN SUCH PATIENTS.

Abstract

Background: Bloodstream infections (BSIs) are among the significant causes of morbidity and mortality for patients of all age groups world-wide. However, very little is known about the trends of bacterial bloodstream infections and anti microbial susceptibilities among adult population from North India. Based on the knowledge of local antimicrobial activity profiles of the most common bacteria causing such infections.drug resistant pathogens are becoming the most challenging problem and they have different economic and social impacts around the world.

Objective: To study the clinical profile, etiological profile, antibiotic susceptibility, focus of infection and in hospital outcome among bacteremia suspected patients in SKIMS from September 2017 to August 2019.

Study design: This was a prospective observational study.

Participants: Cases above 14 years of age with clinical features of Systemic Inflammatory Response Syndrome (SIRS) were included in this study.

Material and methods:. Data was collected at bedside from patients of BSI in different medical and surgical ward including ICU and were followed for their outcome in hospital stay.

Results: Among a total of 136 cases of BSI,32(23.5%) were community acquired BSI and 104(76.5%) hospital acquired BSI. Culture positivity rate was highest (62%) in males and in age group of  >60years (41.2%). Gram negative organisms were predominant (78.7%) than Gram negative organisms(18.4%). Candida albicans 2 (1.5%)  and Brucella melitensis 2 (1.5%)  were isolated from 2 (1.5%) . The most common gram positive bacteria isolated was staphylococcus aureus (56%) and the most frequent gram negative isolate was Burkholderia cepecia (38.3%). The most sensitive sensitive drugs for gram-positive isolates were vancomycin, linezolid and teicoplanin while as gram negative isolates showed high sensitivity to Colistin, tigecycline and Amikacin. Respiratory tract (27.2%) was the most common focus of infection for BSI, followed by central line associated (19.1%) , Urinary tract ( 14.7%) , Gastro Intestinal ( 14%) , hepatobiliary (6.6%) , bone joint (5.1%) , CNS (5.1%) , skin and soft tissue (3.7%) , Head and neck (1.5%) and CVS (1.5%).  In hospital mortality rate was 33%. Mortality was high in HA-BSI (36.5%)  than CA-BSI (22%) .

Conclusion:

• A higher rate of antimicrobial resistance among gram negative and gram positive organisms is an alarming issue.
• Rational use of antibiotics.
• Formulations of antibiotic policy.
• Prompt therapy of bloodstream infections for the effective management and prevention of drug resistance are urgently needed in our setting.

Implication: formulation of new antibiotic policy