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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 14  |  Issue : 4  |  Page : 142-143

Antimicrobial surveillance associated with bloodstream infection in children: A tertiary care hospital-based observation


NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India

Date of Web Publication22-Nov-2016

Correspondence Address:
Partha Bhattacharjee
NH Rabindranath Tagore International Institute of Cardiac Sciences, 124, Mukundapur, EM Bypass, Kolkata - 700 099, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-4651.194489

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How to cite this article:
Bhattacharjee P. Antimicrobial surveillance associated with bloodstream infection in children: A tertiary care hospital-based observation. Curr Med Issues 2016;14:142-3

How to cite this URL:
Bhattacharjee P. Antimicrobial surveillance associated with bloodstream infection in children: A tertiary care hospital-based observation. Curr Med Issues [serial online] 2016 [cited 2019 Nov 13];14:142-3. Available from: http://www.cmijournal.org/text.asp?2016/14/4/142/194489

Sir,

Bloodstream infections (BSIs) are very common in children and one of the common causes of morbidity and mortality. The rate of BSIs in children is about 20%-50% in developing countries. [1],[2] Children have a weak immune barrier. Moreover, other risk factors and congenital anomalies make children more susceptible to infections. Even self-limiting infections progress to life-threatening sepsis, requiring rapid and aggressive antimicrobial treatment. The incidence of bacteremia in children varies widely, and pathogens are becoming more resistant to antibiotics, used by health-care professional. Frequent use of antibiotics possesses a major challenge to treat septicemia in the children. [3]

To understand the susceptibility patterns of BSI pathogens endemic in a Tertiary Care Hospital, Kolkata, India, the antimicrobial susceptibility patterns among 292 patients, age group varying from 2 months to 15 years, were reviewed for a 4-year period (2011-2014). It has been observed that Gram-positive and Gram-negative bacterial percentage were 4.45% and 95.55%, respectively. Klebsiella spp. (50%) and Acinetobacter spp. (17.47%) were the most frequent and common causative agent for BSIs [Table 1]. About half of the Klebsiella spp., isolates tested were resistant to ceftriaxone, cefepime, cotrimoxazole, and piperacillin-tazobactam. The rate of Escherichia coli resistance to ceftriaxone and cefepime was similar to that of Klebsiella spp. Both the organisms showed more susceptibility to polymyxin B and colistin [Table 1]. Staphylococcus aureus was highly susceptible to linezolid and vancomycin and more resistance to cotrimoxazole and oxacillin.
Table 1: Antimicrobial susceptibility profile of isolated bacteria


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For management of septicemia, bacteriological culture is the keystone and such culture result takes time; therefore, understanding the regional bacterial susceptibility and pattern of resistance to antimicrobial agents are very important to prepare treatment guidelines in a developing country where the uses of antibiotics are frequent and multidrug resistant strains are much higher, especially in the children compared to other countries in the world. In previous two other studies which were conducted during 1995-2000 and 2001-2005, the prevalence of Gram-positive bacteria was reported as 72.0% and 47.6%, respectively. [4],[5] However, the recent trend has changed and data showed that the Gram-negative microorganisms have taken a lead role and become much more prevalent. This study data also show that the recent pattern of antimicrobial resistance in Tertiary Care Hospital in Kolkata is similar with the other parts of the India. [6]

This study shows that the Gram-negative isolates from blood in children are more susceptible to the aminoglycosides, carbapenems, and polypeptides, mixed response from the quinolones but more resistance to penicillin group of antibiotics. This study also shows that the Klebsiella spp. is the most common pathogen for BSIs in children and more resistance to the third and fourth generation of cephalosporins which are a warning message to the health-care professional and medical science and researcher should find the alternate option to treat the BSIs in children to decrease the rate of mortality and morbidity. As it is a retrospective study, root cause analysis of the BSI, correlation with morbidity and mortality, and other markers of sepsis were not possible. Inclusion of these data would have definitely enhanced the utility of this study since the study involves children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Meremikwu MM, Nwachukwu CE, Asuquo AE, Okebe JU, Utsalo SJ. Bacterial isolates from blood cultures of children with suspected septicaemia in Calabar, Nigeria. BMC Infect Dis 2005;5:110.  Back to cited text no. 1
    
2.
De A, Saraswathi K, Gogate A, Fernandes AR. Bacteremia in hospitalized children - A one year prospective study. Indian J Med Microbiol 1995;13:72-5.  Back to cited text no. 2
    
3.
Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: Guidelines by the infectious diseases society of America and the society for healthcare epidemiology of America. Clin Infect Dis 2016;62:1197-202.  Back to cited text no. 3
    
4.
Mamishi S, Pourakbari B, Ashtiani MH, Hashemi FB. Frequency of isolation and antimicrobial susceptibility of bacteria isolated from bloodstream infections at Children's Medical Center, Tehran, Iran, 1996-2000. Int J Antimicrob Agents 2005;26:373-9.  Back to cited text no. 4
    
5.
Pourakbari B, Sadr A, Ashtiani MT, Mamishi S, Dehghani M, Mahmoudi S, et al. Five-year evaluation of the antimicrobial susceptibility patterns of bacteria causing bloodstream infections in Iran. J Infect Dev Ctries 2012;6:120-5.  Back to cited text no. 5
    
6.
Mehta M, Dutta P, Gupta V. Antimicrobial susceptibility pattern of blood isolates from a teaching hospital in North India. Jpn J Infect Dis 2005;58:174-6.  Back to cited text no. 6
    



 
 
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