Online ISSN: 2515-8260

Keywords : Blood culture

Effectiveness of Empirical Antimicrobial Therapy on Clinical Outcome in Adult Critical Care Patients with Sepsis

Amita Dabhi, Chirag Modi, Rachit Patel .

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 2, Pages 1079-1089

Context: Sepsis is one of the leading causes of death in hospital settings. Timely administration of rational and effective antimicrobial therapy, as per hospital’s antibiotic policy, is one of the components of antimicrobial stewardship program. In absence of definitive pathogen identification and susceptibility pattern, initial antibiotic regimen is selected which is defined as empirical antibiotic therapy. Although an empirical antimicrobial policy is in place at our institute, it has not been evaluated since its inception for its effectiveness.
Aims: To assess the adherence to the empirical antimicrobial policy for sepsis and to evaluate its effectiveness on clinical outcome of sepsis in adult critical care patients.
Setting and study design: A prospective, cross-sectional study was conducted in adult non covid critical care units of Shree Krishna Hospital.
Methodology: Following approval from Institutional Ethics Committee, prospective cross-sectional study was conducted from 1st August-2021 to 31st July-2022 at non-covid intensive care units. The adherence to the empirical antibiotic policy was calculated as percentage of patients with sepsis in whom antimicrobial agent was started as per the policy. The effectiveness of the antimicrobial policy was assessed on the basis of the improvement in the clinical and laboratory parameters as well as Sequential organ failure assessment (SOFA) score of the patient over a period of five days.
Statistical analysis: Microsoft Excel 2019, Version 2209 was used for data entry and data analysis. Proportions were calculated using descriptive analysis. Data was analysed using Chi-square calculation. Significance was considered at P-value <0.05.
Results: The adherence to the antimicrobial policy in sepsis was 59.80%, (n = 61 out of 102) whereas adherence to initiation of antimicrobial agent within one hour of diagnosis of clinical sepsis was 96.07% (n =98 out of 102). The antimicrobial agent started as per antibiotic policy was susceptible in culture report in 55.31% (n = 26 out of 47) of patients. Effectiveness of empirical antimicrobial policy in patients with sepsis in adult critical care units based on improvement of SOFA score after five days of diagnosis of clinical sepsis was 51.06%, (n=24 out of 47). There was no significant correlation (P ≥0.05) found between age groups, gender, risk stratification categories, type of blood stream infections and type of organisms isolated, i.e., Gram negative and Gram positive with regards to effectiveness of empirical antimicrobial policy. There was no significant difference noted between improvement in SOFA score of the patients in whom antimicrobial agent was started as per policy and in whom the antimicrobial agent was not started as per policy (P = 0.72).
Conclusion: The adherence to antimicrobial policy for sepsis was low and further studies to evaluate the reasons for low compliance need to be conducted. Although the effectiveness was not significantly different when the antimicrobial agent was started as per policy compared to when it was not started as per policy, we still recommend using antimicrobial agent as per policy in order to avoid non uniformity in prescriptions and development of antimicrobial resistance.

To compare the sensitivity of blood cultures on Day 1 (24 Hours) Day 3 (72 Hours) & Day 5 (120 Hours) in neonatal sepsis

Farooq Ahmed Shah, Sheikh Mushtaq Ahmad, Javeed Iqbal Bhat, Bashir Ahmad Fomda, Syed Wajid Ali, Muzamil Mushtaq

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 2, Pages 993-998

To compare the sensitivity of blood cultures on Day 1(24 Hours) Day 3 (72 Hours) & Day 5(120 Hours) in neonatal sepsis.
Materials and Methods: The study was a hospital based observational study conducted in the neonatal ICU, Dept. of Paediatrics and Dept. Of Microbiology, SKIMS, Srinagar, from 1st January 2016 to 1st June 2017. All those neonates with features of sepsis like lethargy, refusal of feeds, irritability, fever, seizure and deranged lab values like CRP, Procalcitonin, and CBC were considered in study. Before drawing blood culture samples, neonates already on antibiotics were excluded from the study. In addition, participants with incomplete details were also excluded from the study.
Results: In our study 1060 cultures were sent from neonates suspected to have sepsis. A total of 85 cultures were found to be positive with an overall culture positivity of 8%. Out of them 64 (75.3%) were positive within 24 hours of incubation (subsequently referred to as culture positive on day 1), 17 (20.0%) were culture positive on day 3 (within 72 hours of incubation, but not within 24 hours) and 4 (4.7%) were culture positive on day 5 (within 120 hours of incubation but not within 72 hours of incubation).
Conclusion: We recommend incubating cultures for 5 days to pick up additional 5% cases of neonatal sepsis.

Speciation Of Cons Isolated From Blood Culture And Their Correlation With Common Pathogenicity Attributes

Dr. Deepa Hanamaraddi; Dr. Manjunath Hosamani; Dr. Sughosh Kulkarni; Dr. Ashwita Alva; Deepti .S. Patil; Dr. RD Kulkarni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 8, Pages 1200-1208

Purpose: Bacteremia is considered as a major cause of hospital acquired infections. The longer hospital stays and instrumentation on patients has led to increase in incidence of bacteremia. The common source being the normal commensal of the skin, anterior nares and the ear canals of the patients. The common commensal being Coagulase negative staphylococci have not been considered as pathogen for true bacteremia, but because use of intravascular devices and prolonged hospital stay has led these bacteria as a major causative agent. The aim of this study is to know the CoNS species distribution, its biofilm activity and to understand the various pathogenicity attributes causing bacteremia.
Material and Methods: A minimum of 50 CoNS species were collected from positive blood culture samples and identified along with its antibiogram assay. Production of slime was demonstrated by Tissue culture plate method. Other pathogenicity factors were analysed to clinically correlate the true bacteraemia.
Results: Out of 47 isolates, 68.08% were Methicillin sensitive CoNS and 32% were Methicillin resistant CoNS. 53.1% demonstrated slime production and 46.8% were negative for slime production.
Conclusion: CoNS are the major cause for nosocomial infections causing true bacteremia. The identification of CoNS species along with its anti-biogram pattern and its ability to produce biofilm, helps in the better management of cases and to prevent the infections.

A Study of Pathogenic Bacteria Isolated from Blood Culture Samples and Their Antibiotic Sensitivity

Tiwari Palak, Mahi Ishani, Lal Darbari

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 517-525

Background: To diagnose bacteremia blood culture still remains the gold standard despite its limitations. While collecting samples, focus must be given that there is strong association between timing of specimen collection at different time points during admission and their yield.
Methods: A retrospective observational study was carried out by analyzing 100 positive blood cultures from April 2021-April2022. All positive blood culture and sensitivity reports of males and females aged less than one month to 60years were included. A total of 100 positive blood culture cases were taken from the culture and sensitivity register from Microbiology department of Hindu Rao Hospital and details were tabulated using a questionnaire.
Results: The commonest organism found on cultures was Coagulase Positive Staphylococcus (CONS) 34% of the cultures, this was followed by Actinobacter in 17% and Klebsiella pneumoniae in 11% of the culture samples. The most common fungi were Candida in 3% and Budding Yeast which was found in 2% of the samples. The most sensitive antibiotic was Gentamycin (27) which was sensitive for Coagulase-positive SA (12), K. pneumoniae (5), Actinobacter (5), S. typhi (3), E. coli (1) and P. aeuroginosa (1). The second most sensitive antibiotic was Vancomycin (20), which was sensitive for Coagulase-positive SA (9), Enterococcus (4), Methicillin resistant coagulase-positive SA (2), Methicillin sensitive SA (2), Actinobacter (1), MRSA (1), and S. aureus (1).
Conclusion: Positive blood culture is a crucial parameter for both the diagnosis of the patient as well as the associated prognosis, the correct interpretation of the blood culture results is essential. While planning treatment the sensitivity and resistance pattern of pathogens found in blood culture to common antimicrobial agents must be taken into account.

To compare clinical profile and outcome of pediatric patients with sepsis admitted in pediatric and neonatal intensive care unit in a tertiary care hospital of central India

Jyotsna Mishra, Shashikant Patidar, Chayan Chakma, Naresh Bajaj

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 517-524

Background: Sepsis and septic shock cases in the Neonatal intensive care unit (NICU)
and Pediatric intensive care unit (PICU) remain one of the most significant causes of
morbidity and mortality in pediatric patients. Therefore, studying and comparing the
clinical features and outcomes of pediatric patients with sepsis in ICUs are important,
especially in developing countries.
Methods: From 1st July 2021 to 31st December 2021, we have collected data from both of
our pediatric ICU and neonatal ICU of Shyam Shah Medical College using a preformed
proforma. Complete blood count, C - reactive protein and culture sensitivity reports
were used to diagnose or screen sepsis. We compared clinical features, laboratory data,
microbiologic results, and final outcome for patients with sepsis in both NICU and
Results: A total 1509 and 236 cases with sepsis from both NICU and PICU respectively
are included in the study (mean duration of stay in NICU 8.9 days±4.3; in PICU 12.5
days±5.3). Among these cases, culture positive cases with sepsis were 66% and 28% in
NICU and PICU respectively. Common pathogens isolated from blood cultures were E.
coli and pseudomonas in NICU and E.coli and S. aureus in PICU. Mortality, discharges,
refers and Left against medical advice cases were compared as outcomes in our study.
Comparing with NICU (n=24, 10.1%), mortality due to sepsis in PICU (n=111, 7.3%)
was less.
Conclusion: Sepsis in children both in NICU and PICU is associated with high mortality
despite aggressive treatment strategies, but more in NICU. Early recognition and
prompt treatment is the key to improve outcome of sepsis.

Prognostic significance ofProcalcitonin, High sensitivity C-reactive proteinandwhite blood cell count incomparison withblood culture in ICU patients with Sepsis and Septic shock inatertiary care Hospital

Dr.Kondle Raghu; Dr. Krishnan Ramalingam

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 2263-2270

Background: Sepsis is a life-threatening condition in ICU with high morbidity and
mortality. Biomarkers which can act as a predictor for diagnosis, prognosis, and patient
outcome in sepsis are needed.
Aim:Aim of the study is to compare the significance of hs-C-reactive Protein (CRP),
Procalcitonin, White blood cell count, and blood culture in patients with bloodstream
infections and compare their prognostic significance with blood cultures in sepsis.
Materials and Methods: This hospital based prospective observational study was conducted
between July 2018 to July 2019 forone year with 216 cases of sepsis. Serial determination
of Procalcitonin and CRP at admission and Day 6 was done. Data was analyzed check to
compare the prognostic significance of the PCT, CRP, and WBC count.
Results:A blood culture positivity rate of 50.9% was reported with male preponderance.
WBC count has significantly reduced after 72hrs of admission (p= 0.007). CRP levels have
significantly reduced on day 6 (p = 0.043) in comparison to at the time of admission (p=
0.032). The serial determination of PCT levels at admission and on day 6 (p= 0.032) was
found to be a better prognostic indicator in patients with sepsis than at the time of
admission. The significant patient outcome in terms of mortality and reduction in length of
hospital stay has been found (p= 0.018, p=0.002). The positive correlation of PCT and CRP
and SOFA score has been reported.
Conclusion: Prognostic significance was found for the biomarkers PCT, CRP, and WBC
count with significant patient outcomes in terms of mortality and hospital stay reduction

Aetiological profile, risk factors, antibiotic sensitivity pattern and outcome of neonatal sepsis in tertiary care hospitals- a prospective observational study


European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1073-1087

Introduction:Neonatal sepsis is an important cause of morbidity and mortality in developing countries.According to the World Health Organization(WHO),around5 million newbornsdie yearly, 98% of deaths occurring in developing countries
Objectives: To identify prevalence of neonatal sepsis,aetiological profile,antibiotic sensitivity pattern and outcome in a tertiary care centre and to formulate a consensus recommendation for empirical antibiotic usage for neonatal sepsis in our hospital.
Method:A hospital based prospective observational study was done from March 2019 to August 2020 on babies diagnosed or suspected as cases of neonatal sepsis in our hospital.
Results:Atotal of 200 neonates were included in our study with clinical suspicion of sepsis during the study period. 127 (63.5%) neonates were identified as EOS (0-3 days) and 73 (36.5%) aslate onset sepsis (4-28 days).Prematurity was thecommonest predisposing factor(68.5%).Feeding intolerance was the commonest presentation (74%).Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of C-reactive protein (CRP) + absolute neutrophil count (ANC) were 93.8% ,90.8%, 34.9%, 99.6% and 90.9% respectively.(p <0.001).Klebsiella pneumonia + Klebsiellaoxytoca(16+1) was the most common isolate (35.4%),There were 6 (12.5%) isolates of Staphylococcus aureus out of which 2 were methicilin resistant aureus(MRSA).
Conclusions:Of the 200 neonates with suspected neonal sepsis,63.5% had EOS. Prematurity was the commonest predisposing factor(68.5%) and feeding intolerance was the commonest presentation (74%).Klebsiella (35.4%) was the most common isolate.