Parajuli Narayan Prasad, Parajuli Hridaya, Pandit Roshan, Shakya Jyotsna, Khanal Puspa Raj
Department of Clinical Laboratory Services, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal.
Department of Laboratory Medicine, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal.
Can J Infect Dis Med Microbiol. 2017;2017:8763135. doi: 10.1155/2017/8763135. Epub 2017 Apr 6.
Bloodstream infections (BSIs) are among the significant causes of morbidity and mortality for patients of all age groups. However, very little is known about the trends of bacterial bloodstream infections and antimicrobial susceptibilities among pediatric and adult population from Nepal. In this study, we have investigated the different etiological agents responsible for bloodstream infections among pediatric and adult patients and the role of drug resistant organisms in these infections at a tertiary care teaching hospital of Kathmandu, Nepal. A total of 3,088 blood culture specimens obtained from pediatric and adult patients suspected to have bloodstream infections were processed by standard microbiological methods. Significant bacterial pathogens were identified by morphological, biochemical, and serological methods as suggested by American Society for Microbiology. In vitro antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method and interpreted according to the guidelines of Clinical and Laboratory Standards Institute. Overall, incidence of bloodstream infections among the suspected patients was 7.48%. Pediatric patients ( = 90, 9.37%) were the significant subgroup of patients affected with bloodstream infections compared to adults ( < 0.05, CI-95%). Gram positive ( = 49, 54.4%) bacteria in pediatric and gram negative bacteria ( = 141, 78.7%) in adult patients were the most common isolates for BSI. ( = 41, 45.6%) in pediatric patients and ( = 40, 28.3%) in adult patients were the leading pathogens. Trends of antimicrobial resistance among isolated bacterial strains were significantly high in adults compared to pediatric patients. Methicillin resistant (MRSA) (31.4%), extended spectrum beta-lactamase (ESBL) (12.5%), and metallo-beta-lactamase (MBL) (3.9%) producing gram negatives were major resistant strains. Our study shows higher rates of bloodstream infections in pediatric patients compared to adult patients. Alarming rates of antimicrobial resistance among blood culture isolates is a serious issue. Prompt and accurate diagnosis and rational antimicrobial therapy are extremely needed.
血流感染（BSIs）是所有年龄段患者发病和死亡的重要原因之一。然而，对于尼泊尔儿童和成人人群中细菌性血流感染的趋势以及抗菌药物敏感性，人们了解甚少。在本研究中，我们调查了尼泊尔加德满都一家三级护理教学医院中儿童和成人患者血流感染的不同病原体，以及耐药菌在这些感染中的作用。通过标准微生物学方法对从疑似患有血流感染的儿童和成人患者中获取的3088份血培养标本进行了处理。按照美国微生物学会的建议，通过形态学、生化和血清学方法鉴定重要的细菌病原体。采用 Kirby-Bauer 纸片扩散法进行体外抗菌药物敏感性试验，并根据临床和实验室标准协会的指南进行解读。总体而言，疑似患者中血流感染的发生率为7.48%。与成人相比，儿童患者（n = 90，9.37%）是受血流感染影响的重要亚组患者（P < 0.05，95%CI）。儿童患者中革兰氏阳性菌（n = 49，54.4%）和成人患者中革兰氏阴性菌（n = 141，78.7%）是血流感染最常见的分离株。儿童患者中的肺炎克雷伯菌（n = 41，45.6%）和成人患者中的大肠埃希菌（n = 40，28.3%）是主要病原体。与儿童患者相比，成人分离菌株中的抗菌药物耐药趋势明显更高。耐甲氧西林金黄色葡萄球菌（MRSA）（31.4%）、产超广谱β-内酰胺酶（ESBL）（12.5%）和产金属β-内酰胺酶（MBL）（3.9%）的革兰氏阴性菌是主要耐药菌株。我们的研究表明，儿童患者的血流感染率高于成人患者。血培养分离株中令人担忧的抗菌药物耐药率是一个严重问题。迫切需要及时、准确的诊断和合理的抗菌治疗。
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