Blood Stream Infections

There are some potential limitations of this study that should be discussed briefly. Blood stream infections from Korle-Bu were identified as including TS and NTS which constituted 6.5% of blood culture positive isolates. Whereas this may reflect the relative incidence of organisms in a Ghanaian tertiary care setting biased by its referral policies, we were unable to determine if these were nosocomial in- cidents or community acquired infections because of insuf- ficient data on inpatient and outpatient status. Another issue worth mentioning is the unavailability of data on nalidixic acid screening for the detection of reduced susceptibility of fluoroquinolone. To test for in vivo fluoro- quinolone resistance, in vitro nalidixic acid is more appro- priate. Quinolone-therapy will fail in spite of apparent ciprofloxacin sensitivity if first resistance mutations have occurred leading to in-vitro nalidixic acid resistance. Note also that by being retrospective, some patients had been stratified with predetermined definitions to which we were unable to fully assess clinical history for correlations that might contribute to the risk of TS or NTS infections. Pa- tient clinical outcome data would have been very helpful in the contextual interpretation of the multi-drug resistant strain infections. Despite these shortcomings, our findings offer baseline information needed to create the awareness of salmonellae blood stream infections in Ghanaian hospi- tals, and also the need for surveillance and control.

November 2011 Start Smart Then Focus launched [57]. Guidance to NHS acute Trusts on antimicrobial stewardship. Abbreviations: A&E, accident and emergency; BSI, blood stream infections; CMO, Chief Medical Officer; CVC, central venous catheter; HAI, hospital-acquired infection; HCAI, healthcare-associated infection; ICU, intensive care unit; MRSA, methicillin-resistant Staphylococcus aureus; NHS, National Health Service;

Risk factors associated with bloodstream infec- tion using Catheter related Blood stream infections may be related to preexisting diseases and clinical factors, such as admission to Intensive Care Units (ICUs), use of mechanical ventilation, and invasive hemodynamic monitoring. Also emphasized as risk factors are the type of catheter material, failure to follow the recommended technique for insertion and maintenance of the catheter, infusion of blood transfusion, more than one indication for use of the device and femoral insertion site [3].

from the study period, catheter removal is required for all episodes of bacteremia with the exception of coagulase-negative Staphylococci. For bacteremia due to coagulase-negative Staphylococci, the CVC may be retained unless there is clinical deterioration or persist- ent or relapsing bacteremia [15]. Relapse was defined as a repeat positive blood culture with the same species occurring more than two weeks and less than eight weeks from the initial positive blood culture. Secondary outcomes included the frequency of catheter-related blood stream infections (CRBSI) and hospitalization due to CRBSI. In both renal programs, it is standard practice for HD unit staff to draw blood cultures when an infec- tion is suspected clinically (i.e. fever) in the absence of another obvious source of infection. Two adjudicators reviewed the microbiology to confirm which were con- firmed CRBSI, possible CRBSI, or secondary sources of bacteremia. A third adjudicator served to resolve any discrepancies. A confirmed CRBSI was defined as one or more blood cultures positive for an opportunistic patho- gen (defined a priori) or two or more blood cultures positive for common skin contaminants, drawn within two days of each other. A possible CRBSI was defined as a single blood culture positive for a common skin contaminant. As peripheral blood cultures may not be feasible in HD patients (i.e. due poor peripheral access or saving a vein for future vascular access creation), differential time to positivity was not a requirement for the diagnosis of CRBSI. For episodes of bacteremia not meeting the above criteria, bacteremia from a secondary source was determined based on culture from another source or clinical judgment. Hospitalization due to CRBSI was defined as any hospitalization occurring during the two-week window following the first positive blood culture and any hospitalization with a repeat positive blood culture of the same species within six- months of the first positive blood culture.

Copyright © 2016 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no fi nancial relationships relevant to this article to disclose. To cite: Reichert F, Piening B, Geffers C, et al. Pathogen- Specifi c Clustering of Nosocomial Blood Stream Infections in Very Preterm Infants. Pediatrics. 2016;137(4):e20152860 WHAT’S KNOWN ON THIS SUBJECT: Nosocomial infections in neonatal intensive care tend to run in clusters. Calculating pathogen-specifi c transmission probabilities requires large databases.

Background: Patients with multiple myeloma are generally immune-compromised either due to pronounced depression in primary antibody responses or because of anti-myeloma therapy. Infection is a major risk factor for early deaths among these patients. The impact of blood stream infections (BSI) on newly diagnosed myeloma patients has been less studied. We aimed to study the incidence and risk factors of BSI within 3 months after diagnosis of multiple myeloma in a tertiary referral center.

However, central venous catheterisation may cause complications such as arterial puncture, major bleeding, occlusive thrombosis and systemic sepsis. Central venous catheter-related blood stream infections (CRBSI) are of particular interest as indwelling vascular catheters have been shown to be responsible for about 62% of ICU acquired blood stream infections 3 which added to the morbidity and mortality of ICU stay 4 . In addition, CRBSI has been shown to increase both ICU and hospital length of stay 5, 6 .

Abstract Background: Continuous surveillance of pattern of blood stream infection is necessary in febrile neutropenia especially with the recent escalating trend in the management of pediatric cancer pa- tients towards intensified regimens and with the increase in infections caused by resistant organ- isms limiting the choice of antibiotics. Aim: Monitoring if a change has occurred in pattern of blood stream infections (BSI) in febrile neutropenic (FN) pediatric cancer patients. Methods: Surveil- lance of FN episodes with positive BSI was prospectively monitored and compared to a previous surveillance in the same pediatric oncology unit. Results: A total of 232 BSI positive episodes were documented in 192 patients during a 6 months period. The results of recent surveillance analysis showed an increase in intensified regimens of chemotherapy, antimicrobial resistance, and pro- longed duration of episodes when compared to previous surveillance, with a p value of <0.001, 0.005, and <0.001, respectively. There was an apparent decrease in the crude mortality but this was not statistically significant, 6% in 2011 and 10% in 2006. Conclusion: The pattern of BSI at our institution is still inclining towards gram positive organisms but is showing a shift towards more antibiotic resistance and prolonged episodes.

Fourteen (14 of 151, 9.2%) episodes of bacteremia were associated with VRE in 11 individual patients (Table 1). One small-bowel transplant patient had three episodes of VRE blood-stream infections over a 4-year period. The first and third episode (2004 and 2007), were caused by E. faecium , while the second episode was caused by E. faecalis (2005). A renal transplant patient had two episodes of bacteremia 10 months apart. In the unadjusted model, girls were more likely to develop VRE-BSI (OR = 1.45; P = .63) (Table 1). When compared with younger and older children, those between 2 and 6 years of age were at higher risk of developing VRE blood-stream infection (OR = 3.8; CI = 1-14; P = .055).

The alarmingly high rates of access-related blood- stream infections (AR-BSI) in patients undergoing dialy- sis with a CVC has forced changes in clinical practices that include better anti-infective protocols, increasing adoption of catheter lock solutions, and better anti- microbial surveillance protocols in order to reduce CVC-related infection rates [15–18]. It is unclear, how- ever, to what extent these changes have curbed the high rates of AR-BSI in the context of an increasing elderly HD phenotype with a high burden of complex health problems. It is also uncertain whether any benefit de- rived from these measures extends to very high-risk groups especially the elderly, patients with diabetes and those dialysed with a femoral CVC. While the formation of a functioning AVF is the preferred vascular access, this is not easily attainable in all individuals, especially elderly patients on HD [19]. Furthermore it remains controversial whether CVCs are superior to AVFs among elderly patients undergoing dialysis with a re- cent study finding lower rates of catheter-related bac- teraemia in elderly patients compared to younger patients [18, 20–22].

CERTIFICATE This is to certify that this dissertation titled “ A STUDY ON MICROBIOLOGICAL PROFILE OF BLOOD STREAM INFECTIONS IN PATIENTS ADMITTED IN INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL” is a bonafide record of work done by DR.N.DEEPA, during the period of her Post graduate study from 2009 to 2013 under guidance and supervision in the Institute of Microbiology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai-600003, in partial fulfillment of the requirement for M.D. MICROBIOLOGY degree Examination of The Tamilnadu Dr.M.G.R. Medical University to be held in April 2013.

Blood stream infections (BSIs) are a serious problem in patients with hema- tologic malignancies receiving allogeneic hematopoietic stem cell transplan- tation (ASCT). We evaluated the clinical utility of molecular diagnosis for the management of BSIs in such patients. We prospectively performed a polyme- rase chain reaction (PCR) analysis of microbial DNA in blood samples from 10 consecutive patients with hematological malignancies at least once a week for one month after ASCT. In total, 51 and 54 samples were analyzed by bac- terial and fungal PCR assays, respectively. Bacteria were detected in 24 sam- ples from 8 patients by PCR, but in only 2 samples from one patient by blood culture. Notably, the bacteria detected in at least half of the 24 samples were considered to have originated from the oral cavity. Fungi were detected in 5 samples from 3 patients by PCR, but not by blood culture. Most cases with positive PCR results were manageable with empirical antimicrobial therapy without disclosure of DNA data. Our DNA analyses did not directly contri- bute to management of BSIs, but did provide valuable microbiological evi- dence for the patients. Additionally, oral management appears to require a critical re-evaluation to reduce the occurrence of BSIs in ASCT recipients.

Here, we report clinical significance and outcomes of pediatric health care associated BSIs caused by ESBL- producing and ESBL-non-producing K. pneumoniae, over the 5 years study period. In the present study, in 5 years period we observed 62% ESBL production in K. pneumoniae, causing BSI. Blood stream infections are one of the most important complications of health care settings. In a multi-centered study of nosocomial infec- tions in pediatric patients, 36% had bacteremia and 37% of patients constituted gram-negative bacilli [2]. Ex- tremely resistant strains are coming into view in several gram-negative microorganisms with resistance to all commonly used antimicrobials [18]. In early reports along Europe, 37.5% of K. pneumoniae were ESBL- producer [2]. Felder K et al. reported that ESBL- producing strains ranged from 20.3% to 22.5% [19]. Many other regions worldwide stated a prevalence of ESBL in Enterobacteriacea spp. approximately 10–35% [20]. Statistics vary widely from continent to continent and from center to center, with prevalence up to 70% [21]. Our higher result compared to literature may pos- sibly be attributed to our patient spectrum, consisting of many clinically high risky groups including hematology- oncology malignancies, patients in intensive care units and neonates. These groups need a variety of interven- tions, accompanying long lasting and combined therap- ies during their hospital stay. Furthermore, analysis of distribution of isolates by years revealed a peak in 2014. We have been strictly following the deviations of these infections in our hospital. According to our remarkable numbers, we introduced some regulatory preventive strategies. The precautions include isolation of the pa- tients with antibiotic resistant microorganisms, follow- up of isolated patients, effective study of committee of hand hygiene including vigorous education of personnel, control of inappropriate broad spectrum antibiotic use, especially including carbapenems.

CERTIFICATE - II This is to certify that this dissertation work titled “Isolation and phenotypic characterisation of bacterial isolates from catheter related blood stream infections in patients on haemodialysis in a tertiary care hospital” of the candidate Dr. S.K.Vidhya with registration Number 201614254 for the award of Doctor of Medicine in the branch of Microbiology. I personally verified the urkund.com website for the purpose of plagiarism Check. I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 4% percentage of plagiarism in the dissertation.

The Gram-positive organisms were uniformly sensitive to Levofloxacin and Linezolid. Except for Klebsiella oxytoca, the Gram-negative organisms tested against Levofloxacin were uniformly sensitive. Levofloxacin should be adopted as a first line antimicrobial for blood stream infections in our environment, considering

Abstract Objective: To determine the pattern of blood stream infections and their antibiotic susceptibility profile with infectivity predictors in a neonatal setting. Methods: The descriptive cross-sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from December 1, 2016,to April 30, 2018, and comprised blood culture samples received in Bactec/BactAlert paediatric bottles from neonates aged 0-30 days admitted in the neonatal intensive care unit. The samples were processed as per the standard guidelines.

Rates of colonization increase in hospitalized patients particularly in those who have been hospitalized for extended periods or / and have received broad spectrum antimicrobial therapy/chemotherapy. 10 Most of the non- fermenters cause nosocomial blood stream infections particularly in debilitated and immunocompromised hosts and are usually multidrug resistant. Data from the Surveillance and Control of Pathogens of Epidemiological importance (SCOPE) study revealed that approximately one-fourth of gram-negative bacteraemia were attributed to NFGNB. 11

The detection rate by PCR was higher than that ob- tained by blood culture, which detected bacterial DNA in 9 of the 44 CSF samples only (Fig. 3). However, all Fig. 2 Efficiency of human DNA removal and sensitivity of PCR assay. a Residues of human DNA after MCLB-1 treatment were monitored via beta-globin derived amplification assays. Upper panel gel based PCR assay targeting the beta-globin gene; lower panel is SYBR green based real-time PCR to quantify residual beta-globin gene fragments. b Detection limits of spiked E. coli at various densities. At high density of spiked bacteria (1000 CFU/ml or 10000 CFU/ml), removal of human DNA does not provide a significant diagnostic signal, but at low concentration (100 CFU/ml or 10 CFU), removal of human DNA enhances detection limit of the diagnostics PCR to 10 CFU/ml

-Evolution to death: Mortality was considered related to bacteraemia if the death was related to bacteraemia during hospital admission. -Diagnosis of catheter-related bacteraemia has been refered to the Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) definitions. “Catheter related blood stream infection was suspected in patients with intravenous catheters and fever, chills or other signs of sepsis, even in the absence of local signs of infection, and especially if no alternative source was identified”. Positivity of blood cultures obtained through the catheter ≥ 2 hours before those obtained from a peripheral vein with the same microorganism was highly suggestive of catheter related blood stream infection”. “In the case of skin com- mensals, at least 2 positive blood cultures with an identi- cal strain are required for them to be considered a cause of bacteremia catheter related blood stream infection. In this sense patients with only one positive blood culture were considered a cause of bateremia catheter related blood stream infection if it was combined with a positive catheter hubs with the same microorganism and same antibiogram or sugestive symthoms as they have been defined before taking in account the growth time of cul- tures. Semiquantitative cultures of catheter hubs with

The patterns and rates of resistance for the Gram-nega- tive organisms and for MRSA in this study are surprisingly high and cause a great deal of concern with respect to infection control practices and antibiotic prescribing practices. A relatively high resistance of P. aeruginosa strains against cephalosporins (cefepime and ceftazidime) was observed, and Acinetobacter spp demonstrated extensive resistance, again implicating that the transmission of these organisms is likely hospital-acquired. Enterobacter infections are a known surrogate in the NICU for nosocomial transmission. 6 Also, the Gram-negatives Klebsiella, Pseudomonas, and Acinetobacter are ‘water-bugs’ and can cause common-source outbreaks because they can live in multi-use medication vials, soap, and inadequately processed equipment. 4 The current standard practice of using empiric ampicillin and gentamicin for sus- pected neonatal sepsis needs further critical appraisal as this combination has historically been used to target GBS, E. coli, and Listeria. However, outside the developed world these are often not the offending organisms and this standard regimen may not be active in the face of growing drug resistance seen primarily among Gram-negative organisms.