Evaluation of microorganisms isolated from blood cultures and their susceptibility profiles to antibiotics in five years period

Abstract

Aim: In starting antibiotic treatment to know the distribution of infectious agents and the antibiotic resistance rates is vital especially in critically ill patients to prevent disease progression. In this study we aimed to determine the distribution and antimicrobial resistance patterns of blood culture isolates obtained in a tertiary center. 

Methods: The microbiological laboratory records between January 2014 and December 2018 were retrospectively reviewed. Each conventional aerobic blood culture bottle per patient with positive results was recorded with the antimicrobial susceptibility profiles of the bacteria isolated. Descriptive statistics (number, percentage, mean and median) were performed. Comparison of descriptive data between groups was performed with cross tables and chi square test. One-way ANOVA test was used to compare the antibiotic resistance rates between spp.

Results: A total of 66004 blood cultures were analyzed in this cross-sectional study. Of the 3882 (21.0%) positive results, 3256 (4.9%) were identified as contamination. The most commonly isolated microorganisms were Coagulase negative staphylococcus, Escherichia coli, Klebsiella spp., Staphylococcus aureus and Acinetobacter spp. Extended spectrum β-lactamase (ESBL) positivity was determined in 236 (62.4%) isolates of E.coli, and 186 (56.8%) isolates of Klebsiella spp. Vancomycin resistance showed a significant increase in Enterococcus spp. in time. E.coli did not show any resistance to imipenem, meropenem, tigecycline or colistin. Methicillin susceptible Staphylococcus aureus (MSSA) and methicillin resistant Staphylococcus aureus (MRSA) did not show any resistance to vancomycin, teicoplanin, linezolid or daptomycin. In Enterococcus spp., tigecycline resistance was 1.9%, while daptomycin and linezolid resistance were not determined. The most effective resistance agent to Acinetobacter spp. and Pseudomonas spp. was colistin. Fungal infection was detected in 156 patients. Candida albicans and Candida parapsilosis complex were the most common isolates. 

Conclusion: Antibiotic resistance rates are increasing in all over the world. Rational antibiotic usage may aid the clinicians to overcome this condition. Epidemiological data is important in this regard.

Keywords

• Blood culture,Antibiotics susceptibility,Microorganisms

Beş yıllık sürede kan kültürlerinden izole edilen mikroorganizmaların değerlendirilmesi ve antibiyotiklere duyarlılık profilleri

Öz

Amaç: Enfeksiyöz ajanların dağılımını ve antibiyotik direnç oranlarını bilmek, hastalığın ilerlemesini önlemek için antibiyotik tedavisine başlamada hayati öneme sahiptir. Bu çalışmada, Türkiye'de beş yıllık bir dönemde üçüncü basamak merkezimizden elde edilen kan kültürü izolatlarının dağılımını ve antimikrobiyal direnç paternlerini belirlemeyi amaçladık.

Yöntemler: Ocak 2014 - Aralık 2018 arasındaki mikrobiyoloji laboratuvar kayıtları geriye dönük olarak incelendi. Pozitif üreme sonuçları olan hastalar, izole edilen bakterilerin antimikrobiyal duyarlılık profilleri ile kaydedildi. Tanımlayıcı istatistikler (sayı, yüzde, ortalama ve ortanca) yapıldı. Gruplar arasındaki tanımlayıcı verilerin karşılaştırılması çapraz tablolarla ve ki kare testi ile yapıldı. İzolatlar arasındaki antibiyotik direnç oranlarını karşılaştırmak için tek yönlü ANOVA testi kullanıldı.

Bulgular: Bu kesitsel çalışmada toplam 66004 kan kültürü analiz edildi; 3882 (%21,0) pozitif sonuçtan 3256 (%4,9)'sı kontaminasyon olarak tanımlandı. En sık izole edilen mikroorganizmalar, Koagülaz negatif stafilokok, Escherichiacoli, Klebsiella spp., Staphylococcus aureus ve Acinetobacter spp.olarak belirlendi. Extended spectrum β-lactamase (ESBL) pozitifliği, 236 (% 62,4) E.coli izolatı, 186 (%56,8) Klebsiella spp.’de saptandı. Vankomisin direnci zamanla Enterococcus spp.'de anlamlı bir artış gösterdi. E.coli, imipenem, meropenem, tigesiklin veya kolistine karşı herhangi bir direnç göstermedi. Methicillin duyarlı Staphylococcus aureus (MSSA) and methicillin dirençli Staphylococcus aureus (MRSA), vankomisin, teikoplanin, linezolid veya daptomisine karşı herhangi bir direnç göstermedi. Enterococcus spp.'de tigesiklin direnci %1,9 iken daptomisin ve linezolid direnci saptanmadı. Dirençli Acinetobacter spp. ve Pseudomonas spp. için en etkili ajan kolistin'di. 156 hastada mantar enfeksiyonu saptandı. Candida albicans ve Candida parapsilosis complex en sık izolatlardı.

Sonuç: Antibiyotik direnç oranları tüm dünyada artmaktadır. Akılcı antibiyotik kullanımı klinisyenlerin bu durumu aşmalarına yardımcı olabilir. Bu konuda epidemiyolojik veriler önemlidir.

Anahtar Kelimeler

• Kan kültürü,Antibiyotik duyarlılığı,Mikroorganizmalar

References

1. 1. Kim HJ, Lee NY, Kim S, Shin JH, Kim MN, Kim EJ, et al. Characteristics of microorganisms isolated from blood cultures at Nine University Hospitals in Korea during 2009. Korean J Clin Microbiol. 2011;14:48–54.
2. 2. Yiş R. Evaluation of blood cultures in a children's hospital located in Southeastern Anatolia. Turk Pediatri Ars. 2015 Jun 1;50(2):102-7.
3. 3. Dat VQ, Vu HN, Nguyen The H, Nguyen HT, Hoang LB, Vu Tien Viet D, et al. Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome. Wertheim HFLBMC Infect Dis. 2017 Jul 12;17(1):493.
4. 4. Deen J, von Seidlein L, Andersen F, et al. Community-acquired bacterial bloodstream infections in developing countries in south and southeast Asia: a systematic review. Lancet Infect Dis. 2012;12:480-7.
5. 5. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 Jun;34(6):1589-96.
6. 6. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Twenty-fourth informational supplement update. CLSI document M100-S24. Clinical and Laboratory Standards Institute, Wayne, PA (2014).
7. 7. EUCAST. EUCAST Clinical Breakpoint Table Version 6.0, Valid From 2016-01-01. Basel: EUCAST, 2016. http://www.eucast.org/clinical_breakpoints/
8. 8. Forbes BA, Sahm DF, Weissfeld AS. Bloodstream infectious. Bailey and Scott’s Diagnostic Microbiology. 12th ed. St. Louis: Mosby Elsevier, 2012:778-97.

9. 9. Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis. 2001 May 15;32 Suppl 2:S114-32.
10. 10. Wattal C, Raveendran R, Goel N, Oberoi JK, Rao BK. Ecology of blood stream infection and antibiotic resistance in intensive care unit at a tertiary care hospital in North India. Braz J Infect Dis. 2014 May-Jun;18(3):245-51.
11. 11. Mehdinejad M, Khosravi AD, Morvaridi A. Study of prevalence and antimicrobial susceptibility pattern of bacteria isolated from blood cultures. J Biol Sci. 2009;9:249–53.
12. 12. Yılmaz S, Gümral R, Güney M, Bedir O, Üsküdar Güçlü A, Duyan S, et al. İki yıllık dönemde kankültürlerinden izole edilen mikroorganizmalar ve antibiyotik duyarlılıkların değerlendirilmesi. Gülhane Tıp Derg. 2013;55:247-52.
13. 13. Sevim S, Öztürk Ş, Coşkuner A, Özgenç O, Avcı M. BACTEC kan kültür sistemi ile izole edilen mikroorganizmaların değerlendirilmesi. Turkish Journal of Infection. 2007;21(3):135-40.
14. 14. Bentley J, Thakore S, L Muir, Baird A, Lee J. A change of culture: reducing blood culture contamination rates in an Emergency Department BMJ Quality Improvement Reports 2016;5:u206760.w275.
15. 15. Sucu N, Çaylan R, Aydın K, Yılmaz G, Aktoz Boz G, Köksal İ. Karadeniz Teknik Üniversitesi Tıp Fakültesi Hastanesinde kan kültürlerinin prospektif olarak değerlendirilmesi. Mikrobiyol Bült. 2005;39:455-64.
16. 16. 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 Sep 15;18(1):1121.
17. 17. 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 Jul-Sep;10(3):332-7.
18. 18. Lee SY, Kotapati S, Kuti JL, Nightingale CH, Nicolau DP. Impact of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species on clinical outcomes and hospital costs: a matched cohort study. Infect Control Hosp Epidemiol. 2006;27:1226–32.
19. 19. Stewardson A, Fankhauser C, De Angelis G, Rohner P, Safran E, Schrenzel J, et al. Burden of bloodstream infection caused by extended-spectrum β-lactamase-producing enterobacteriaceae determined using multistate modeling at a Swiss University Hospital and a nationwide predictive model. Infect Control Hosp Epidemiol. 2013 Feb;34(2):133-43.
20. 20. Fennell J, Vellinga A, Hanahoe B, Morris D, Boyle F, Higgins F, et al. Increasing prevalence of ESBL production among Irish clinical Enterobacteriaceae from 2004 to 2008: An observational study. BMC Infect Dis. 2012 May 15;12:116.
21. 21. Health Protection Surveillance Centre Annual Report 2007. [ http://www.hpsc.ie/hpsc/AboutHPSC/AnnualReports/File,3377,en.pdf]
22. 22. World Health Organization. Antimicrobial resistance global report on surveillance. 2014. https://www.who.int/drugresistance/documents/surveillancereport/en/(Date of access: December 2018).
23. 23. World Health Organization. Central Asian and eastern European surveillance of antimicrobial resistance (CAESAR), Annual report. 2018 http://www.euro.who.int/en/healthtopics/diseaseprevention/antimicrobial-resistance/publications/2017/centralasian-and-eastern-european-surveillance-ofantimicrobial-resistanceannual-report 2017-2018.
24. 24. Neuner EA, Yeh JY, Hall GS, Sekeres J, Endimiani A, Bonomo RA, et al. Treatment and outcomes in carbapenem-resistant Klebsiellapneumoniae bloodstream infections. Diagn Microbiol Infect Dis. 2011;69(4):357-62.
25. 25. Rojas LJ, Salim M, Cober E, Richter SS, Perez F, Salata RA, et al. Colistin resistance in carbapenem-resistant Klebsiella pneumoniae: Laboratory detection and impact on mortality. Clin Infect Dis. 2017;64(6):711-8.
26. 26. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011 Feb 1;52(3):285-92.
27. 27. Köck R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010 Oct 14;15(41):19688.
28. 28. Stover KR, Morrison A, Collier T, Schneider E, Wagner JL, Capino AC, et al. Epidemiology and Risk Factors for Bacteremia in Pediatric and Adolescent Patients. J Pharm Pract. 2019 Aug 26:897190019868056.
29. 29. Holland TL, Arnold C, Fowler VG Jr. Clinical management of Staphylococcus aureus bacteremia: a review. JAMA. 2014 Oct 1;312(13):1330-41.
30. 30. Holubar M, Meng L, Deresinski S. Bacteremia due to Methicillin-Resistant Staphylococcus aureus: New Therapeutic Approaches. Infect Dis Clin North Am. 2016 Jun;30(2):491-507.
31. 31. Narayanan N, Rai R, Vaidya P, Desai A, Bhowmick T, Weinstein MP. Comparison of linezolid and daptomycin for the treatment of vancomycin-resistant enterococcal bacteremia. Ther Adv Infect Dis. 2019 Feb 13;6:2049936119828964.
32. 32. World Health Organization WHO publishes list of bacteria for which new antibiotics are urgently needed. (2017) Available from http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/en/ Accessed 1st Jan 2018
33. 33. El Mekes A, Zahlane K, Ait Said L, Tadlaoui Ouafi A, Barakate M. The clinical and epidemiological risk factors of infections due to multi-drug resistant bacteria in an adult intensive care unit of University Hospital Center in Marrakesh-Morocco. J Infect Public Health. 2019 Sep 16.
34. 34. Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis. 2010;14(11):e954-66.
35. 35. Jung SI, Shin JH, Song JH, et al. Korean Study Group for Candidemia. Multicenter surveillance of species distribution and antifungal susceptibilities of Candida bloodstream isolates in South Korea. Med Mycol. 2010;48(4):669-74.
36. 36. Öztürk T, Özseven AG, Sesli Çetin E, Kaya S. Kan kültürlerinden izole edilen Candida suşlarının tiplendirilmesi ve antifungal duyarlılıklarının araştırılması. Kocatepe Tıp Derg. 2013;14(1):17-22.
37. 37. Fındık D, Tuncer İ, Arslan U. Candida Albicans Türü Maya Mantarlarında Antifungal İlaç Direnci. Serbest bildiri, P07-02. XXIX. Türk Mikrobiyoloji Kongresi, Antalya 8-13 Ekim 2000.
38. 38. Zer Y, Balcı İ. Yoğun Bakım Ünitesindeki Hastalardan izole Edilen Candida Suşlarının İdentifikasyonu ve Antifungal Duyarlılıkları. Türk Mikrobiyol Cem Derg. 2002;32:230-4.
39. 39. Cheng MF, Yu KW, Tang RB, Fan YH, Yang YL, Hsieh KS, et al. Distribution and Antifungal Susceptibility of Candida Species Causing Candidemia from 1996 to 1999. Diagn Microbiol Infect Dis. 2004;48:33-7.
40. 40. Aydin F, Bayramoglu G, Guler NC, Kaklikkaya N, Tosun I. Bloodstream Yeast Infections in a University Hospital in Northeast Turkey: A 4-Year Survey. Med Mycol. 2011;49(3):316-9.
41. 41. Karabıçak N, Alem N. Türlerinin Triazol Antifungal Duyarlılık Profilleri: Antifungal Direncin Belirlenmesinde Yeni CLSI Türe Özgü Klinik Direnç Sınır Değerleri ve Epidemiyolojik Eşik Değerlerinin Uygulanması. Mikrobiyol Bul. 2016;50(1):122-32.
42. 42. Diekema DJ, Messer SA, Boyken LB, Hollis RJ, Kroeger J, Tendolkar S, et al. In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods. J Clin Microbiol. 2009;47(10):3170-7.
43. 43. Etiz P, Kibar F, Ekenoğlu Y, Yaman A. Kan kültürlerinden izole edilen Candida türlerinin dağılımının ve antifungal duyarlılıklarının retrospektif olarak değerlendirilmesi. ANKEM Derg. 2015;29(3):105-13.