Antibiotic susceptibilities and microorganisms isolated from blood cultures of inpatients in a secondary state hospital in Türkiye

Year 2025, Volume: 50 Issue: 1, 1 - 10, 31.03.2025

Eyyüp Kaya , Hamide Kaya , Candan Öztürk

https://doi.org/10.17826/cumj.1548878

Abstract

Purpose: The aim of this study was to evaluate the bacterial species distribution and antibiotic susceptibility in blood cultures obtained from patients in a secondary care center in Mersin, Türkiye.
Materials and Methods: Blood culture specimens of inpatients sent to the microbiology laboratory between January 2022 and December 2023 were retrospectively analyzed to determine the etiologic agents of bloodstream infections and to evaluate their antimicrobial susceptibility. Samples were processed using the BD Bactec FX40 automated blood culture system (BD, USA), which allows continuous monitoring and rapid detection of microbial growth. Typing of causative agents in positive cultures and antimicrobial susceptibility testing were performed using conventional methods and the Vitek2 Compact automated system.
Results: Microbial growth was observed in 369 (42.7%) of 864 patients. Of the microorganisms isolated, 79.4% (293) were Gram-positive bacteria, 18.2% (67) were Gram-negative bacteria and 2.4% (9) were yeasts. Escherichia coli (26.9%) was the most frequently isolated Gram-negative bacterium followed by Acinetobacter baumannii (20.9%), Enterobacter cloacae (13.4%), Klebsiella pneumoniae (13.4%) and Pseudomonas aeruginosa (13.4%). Among Gram-positive bacteria, coagulase-negative staphylococci (81.2%) and Staphylococcus aureus (10.2%) were most frequently isolated. Methicillin resistance was found in 30.0% of S. aureus and 71.8% of coagulase-negative staphylococci. No resistance to vancomycin, tigecycline or daptomycin was observed. Extended-spectrum β-lactamase production was detected in 44.4% of E. coli and 55.5% of Klebsiella spp.
Conclusion: This study highlights the local prevalence of bacterial isolates in bloodstream infections and emphasizes the need for routine monitoring of etiologic agents and antibiotic susceptibility to prevent resistance and aid rational antibiotic use.

Keywords

Blood culture, bloodstream infections, antimicrobial susceptibility, multidrug resistance, sepsis.

Ethical Statement

This study was approved by the Ethical Committee for Clinical Research of the Rectorate of Mersin University with decision number 2023/688 on 18.10.2023.

Supporting Institution

None.

Thanks

None.

Türkiye'de ikinci basamak bir devlet hastanesinde yatan hastaların kan kültürlerinden izole edilen mikroorganizmalar ve antibiyotik duyarlılıkları

Abstract

Amaç: Bu çalışmanın amacı Mersin, Türkiye'de bulunan bir ikinci basamak merkezindeki hastalardan alınan kan kültürlerinde bakteri tür dağılımını ve antibiyotik duyarlılığını değerlendirmektir.
Gereç ve Yöntem: Ocak 2022 ve Aralık 2023 tarihleri arasında yatan hastalardan mikrobiyoloji laboratuvarına gönderilen kan kültürü örnekleri, kan dolaşımı enfeksiyonlarının etiyolojik ajanlarını belirlemek ve antimikrobiyal duyarlılıklarını değerlendirmek için retrospektif olarak analiz edilmiştir. Örnekler, sürekli izleme ve mikrobiyal üremenin hızlı bir şekilde tespit edilmesini sağlayan BD Bactec FX40 otomatik kan kültürü sistemi (BD, ABD) kullanılarak işlenmiştir. Pozitif kültürlerde etkenlerin tiplendirilmesi ve antimikrobiyal duyarlılık testleri konvansiyonel yöntemler ve Vitek2 Compact otomatize sistemi kullanılarak gerçekleştirilmiştir.
Bulgular: 864 hastanın 369'unda (%42,7) mikrobiyal üreme görüldü. İzole edilen mikroorganizmaların %79,4'ü (293) Gram-pozitif bakteriler, %18,2'si (67) Gram-negatif bakteriler ve %2,4'ü (9) mayalardan oluşuyordu. Gram negatif bakteriler arasında en sık izole edilen bakteri Escherichia coli (%26,9) olup sırasıyla Acinetobacter baumannii (%20,9), Enterobacter cloacae (%13,4), Klebsiella pneumoniae (%13,4), Pseudomonas aeruginosa (%13,4) izledi. Gram pozitif bakteriler arasında ise en sık CoNS (%81,2) ve Staphylococcus aureus (%10,2) izole edildi. Metisilin direnci S. aureus'un %30,0'unda ve koagülaz-negatif stafilokokların %71,8'inde bulundu. Vankomisin, tigesiklin veya daptomisine karşı direnç gözlenmedi. E. coli'nin %44,4'ünde ve Klebsiella spp'nin %55,5'inde genişlemiş spektrumlu β-laktamaz üretimi tespit edildi.
Sonuç: Bu çalışma, kan dolaşımı enfeksiyonlarında bakteriyel izolatların yerel yaygınlığını belirtmekte ve direnci önlemek ve akılcı antibiyotik kullanımına yardımcı olmak için etiyolojik ajanların ve antibiyotik duyarlılığının rutin olarak izlenmesi gerektiğini vurgulamaktadır.

Keywords

Kan kültürü, kan dolaşımı enfeksiyonları, antimikrobiyal duyarlılık, çoklu ilaç direnci, sepsis.

Ethical Statement

Bu çalışma Mersin Üniversitesi Rektörlüğü Klinik Araştırmalar Etik Kurulu tarafından 18.10.2023 tarih ve 2023/688 sayılı karar ile onaylanmıştır.

Supporting Institution

Yoktur.

Thanks

Yoktur.

References

• Martinez RM, Wolk DM. Bloodstream infections. Microbiol Spectr. 2016;4: 10.1128/microbiolspec.dmih2-0031-2016..
• Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR et al. Global, regional, and national sepsis incidence and mortality, 1990–2017:analysis for the global burden of disease study. Lancet. 2020;395:200–11.
• Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399:629–55.
• Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49:e1063–143.
• WHO. Global Action Plan on Antimicrobial Resistance. Geneva, World Health Organization, 2015.
• Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS et al. The microbiology of bloodstream infection: 20-year trends from the SENTRY antimicrobial surveillance program. Antimicrob Agents Chemother. 2019;63:e00355-19.
• Basustaoglu A. Kan kültürü uygulama klavuzu. Ankara, Türk Mikrobiyoloji Cemiyeti, 2013.
• EUCAST. The European Committee on Antimicrobial Susceptibility Testing version 13.0, 2023. Copnhagen, EUCAST, 2023.
• Mia A, Zerin T. Antibiogram of blood culture isolates of patients from a hospital in Dhaka, Bangladesh. Matrix Science Medica. 2020;4:1−5.
• Totad Rd, Ganganahalli P. Bacteriological profile and antibiotic sensitivity pattern of blood culture ısolates from tertiary care level teaching hospital of vijaya pura district. Int J Res Med Sci. 2020;8:3974-8.
• Suetens C, Latour K, Karki T, Ricchizzi E, Kinross P, Moro ML et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys 2016 to 2017. Euro Surveill. 2018;23:1800516.
• Oyekale OT, Ojo BO, Olajide AT, Oyekale OI. Bacteriological profile and antibiogram of blood culture isolates from bloodstream infections in a rural tertiary hospital in Nigeria. Afr J Lab Med. 2022;11:1807.
• Cassini A, Colzani E, Pini A, Mangen MJJ, Plass D, McDonald SA et al. Impact of infectious diseases on population health using incidence-based disability-adjusted life years (DALYs): Results from the burden of communicable diseases in Europe study. European union and European economic area countries, 2009 to 2013. Euro Surveill. 2018;23:17- 00454.
• Robledo J, Maldonado N, Robledo C, Ceballos Naranjo L, Hernández Galeano V, Pino JJ. Changes in antimicrobial resistance and etiology of blood culture ısolates: results of a decade (2010–2019) of surveillance in a Northern Region of Colombia. Infect Drug Resist. 2022;15:6067–79.
• Nishanthy M, Saikumar C. Bacteriological profile and antibiotic susceptibility of blood culture ısolates in ıntensive care units of a tertiary care hospital. Int J Life Sci Pharma Res. 2022;12:112-9.
• Arabacı Ç, Kutlu O. Evaluation of microorganisms isolated from blood cultures and their susceptibility profiles to antibiotics in five years period. J Surg Med. 2019;3:729-33.
• Tian L, Sun Z, Zhang Z. Antimicrobial resistance of pathogens causing nosocomial bloodstream infection in Hubei Province, China, from 2014 to 2016: a multicenter retrospective study. BMC Public Health. 2018;18:1121.
• Banik A, Bhat SH, Kumar A, Palit A, Snehaa K. Bloodstream infections and trends of antimicrobial sensitivity patterns at Port Blair. J Lab Physicians. 2018;10:332-7.
• Stewardson AJ, Allignol A, Beyersmann J, Graves N, Schumacher M, Meyer R. et al. The health and economic burden of bloodstream infections caused by antimicrobial–susceptible and non–susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study. Euro Surveill. 2016;21:30319.
• Islam S, Aldstadt J, Aga D. Global antimicrobial resistance: a complex and dire threat with few definite answers. Trop Med Int Health. 2019;24:658−62.
• Farooqui HH, Selvaraj S, Mehta A, Heymann DL. Community level antibiotic utilization in India and its comparison vis-à-vis European countries: evidence from pharmaceutical sales data. PloS One. 2018;13:e0204805.
• WHO. WHO Global Priority List of Antibiotic-Resistant Bacteria yo Guide Research, Discovery, And Development of New Antibiotics; 2017. Geneva, World Health Organization, 2017.
• Agnew E, Dolecek C, Hasan R, Mahra M, Merk H, Perovic O et al. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report; 2021. Geneva, World Health Organization, 2021.
• Zerin T, Islam A, Gulnahar S, Farjana NE, Begum MA, Sadia HE. Identification and antibiotic susceptibility of blood culture ısolates from Rajshahi, Bangladesh. J Sci Res Med Bio Sci. 2021;2:1-10.
• Onelum O, Odetoyin B, Onipede A, Oyelese A. The role of methicillin-resistant Staphylococcus aureus in clinical infections in Obafemi Awolowo university teaching hospitals complex, Ile-Ife, South Western Nigeria. J Microbiol Exp. 2015;2:59-64.
• Haa S, Huha K, Chunga DR, Koa JH, Cho SY, Huh HJ et all. Efficacy of teicoplanin in bloodstream infections caused by Enterococcus faecium: posthoc analysis of a nationwide surveillance. Int J Infect Dis. 2022;122:506-513.
• Esmail MAM, Abdulghany HM, Khairy RMM. Prevalence of multidrug-resistant Enterococcus faecalis in hospital-acquired surgical wound infections and bacteremia: concomitant analysis of antimicrobial resistance genes. Infect Dis. 2019; 12:1178633719882929.
• Perovic O, Ismail H, Quan V, Bamford C, Nana T, Chibabhai V et al. Carbapenem-resistant Enterobacteriaceae in patients with bacteraemia at tertiary hospitals in South Africa, 2015 to 2018. Eur J Clin Microbiol Infect Dis. 2020;39:1287-94.
• Fawzy R, Gad G, Mohamed H. Phenotypic and genotypic detection of resistance mechanisms in carbapenem-resistant gram-negative bacteria isolated from egyptian icu patients with first emergence of ndm-1 producing klebsiella oxytoca. Iran J Microbiol. 2022;14:832-40.
• Tüzemen NÜ, Önal U, Merdan O, Akca B, Ener B, Özakın C et al. Synergistic antibacterial activity of ceftazidime–avibactam in combination with colistin, gentamicin, amikacin, and fosfomycin against carbapenem-resistant Klebsiella pneumoniae. Sci Rep. 2024;14:17567.
• Manyahi J, Kibwana U, Mgimba E, Majigo M. Multi-drug resistant bacteria predict mortality in bloodstream infection in a tertiary setting in Tanzania. PLoS One. 2020;15:e0220424.
• Whiteway C, Breine A, Philippe C, Van der Henst C. Acinetobacter baumannii. Trends Microbiol. 2022;30:199-200.
• Casale R, Boattini M, Comini S, Bastos P, Corcione S, De Rosa FG et al. Clinical and microbiological features of positive blood culture episodes caused by non-fermenting gram-negative bacilli other than Pseudomonas and Acinetobacter species (2020–2023). Infection. 2024.
• Russo A, Bassetti M, Ceccarelli G, Carannante N, Losito AR, Bartoletti M et all. Bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii: clinical features, therapy and outcome from a multicenter study. J Infect. 2019;79:130-8.
• Pfennigwerth N, Kaminski A, Korte-Berwanger M, Pfeifer Y, Simon M, Werner G et al. Evaluation of six commercial products for colistin susceptibility testing in enterobacterales. Clin Microbiol Infect. 2019;25:1385-9.
• Chauhan S, Kaur N, Saini A, Aman S, Chauhan J, Kumar H. Colistin resistant gram-negative bacteria isolated from various clinical samples in north indian tertiary care center. IJPQA. 2022;13:15-23.
• Mirzaei B, Bazgir ZN, Goli HR, Iranpour F, Mohammadi F, Babaei R. Prevalence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) phenotypes of Pseudomonas aeruginosa and Acinetobacter baumannii isolated in clinical samples from Northeast of Iran. BMC Res Notes, 2020;13:380.
• Sezener M, Ergüden V, Findik A, Akgöz S, Gülhan T, Moţco O, et al. Türkiye ve romanya kökenli pseudomonas aeruginosa izolatlarının antibiyotik dirençlerinin, biyofilm oluşumu ve genotiplerinin araştırılması. J Etlik Vet Microbiol. 2022;33:1-6.
• Çaşkurlu H, Davarcı İ, Koçoğlu M, Çağ, Y. Examination of blood and tracheal aspirate culture results in intensive care patients: 5-year analysis. Medeniyet Med J. 2020;35:128-35.
• Mondal AH, Khare K, Saxena P, Debnath P, Mukhopadhyay K, Yadav, D. A review on colistin resistance: an antibiotic of last resort. Microorganisms. 2024;12:772.
• Li D, Rao H, Xu Y, Zhang M, Zhang J, Luo J. Monotherapy vs combination therapy in patients with Klebsiella pneumoniae bloodstream infection: a systematic review and meta-analysis. J Infect Chemother. 2024;30:372-8