Blood stream infection (BSI) is one of the major
causes of morbidity and mortality in pediatric age group; rates upto 25%
have been documented in previous studies from India [1]. However, lack
of a surveillance system masks the pattern of antimicrobial resistance
among childhood BSI across the country [2].
We conducted a review of hospital records to examine
the bacterial organisms and their drug-sensitivity in blood cultures
collected from children (up to 12 years) admitted in a tertiary-care
public hospital in New Delhi during 2014. BSI was assessed according to
CDC/NHSN criteria in children with acute infections, sepsis and
pneumonia [3]. Samples were inoculated in brain-heart infusion broth
(1:10 dilution) and incubated for 7 days at 37șC. Subcultures were
performed on blood agar and MacConkey agar after 48 hours and seven
days. Coagulase negative Staphylococcus (CONS), when isolated,
was confirmed by repeat culture. Antibiotic susceptibility of CONS was
determined by Kirby Bauer disc diffusion method following CLSI
guidelines [4].
A total of 1025 (14.9%) positive isolates were
analyzed. Of them, S. aureus was most common (44.8%), with 63.7%
being methicillin-resistant. Among gram positive isolates, penicillin
resistance was high among both CONS and S. aureus. Among gram
negatives, E. coli was most common (4.6%) followed by
Acinetobacter. Klebsiella showed >60% resistance against
amikacin and ciprofloxacin. Resistance to third generation
cephalosporines was seen in E. coli, Klebsiella and
Enterobactor (Table I).
TABLE I Organism from Blood Culture in Pediatric Sepsis and their Resistance Pattern
Organism |
No (%) |
Resistance pattern |
Staphylococcus aureus |
459 (44.8) |
283/444 (63.7%) methicillin
|
Coagulase-negative Staphylococcus |
254 (24.8) |
168/234 (71.8%) methicillin
|
Enterococcus species |
73 (7.1) |
19/70 (27.1%) vancomycin
|
Escherichia coli |
47 (4.6) |
14/42 (33.3%) 3rd generation cephalosporines
|
Acinetobacter species |
45 (4.4) |
17/44 (38.6%) meropenem
|
Klebsiella species |
39 (3.8) |
3/33 (9.1%) 3rd generation cephalosporines
|
Enterobacter species |
36 (3.5) |
5/29 (17.2%) 3rd generation cephalosporines
|
Similar to the present study, few recent studies have
yielded high proportion of gram-positive bacteria among children in
hospital set-up [5,6]. Indian Network for Surveillance of Antimicrobial
Resistance earlier documented 41% prevalence of MRSA [7], which is much
lower than our report and underscores the calls for strict vigilance
over the amplifying threat of antibiotic resistance.
The prevalence of CONS was similar to a previous
study [8]. The rise in resistance among Acinetobactor against
higher antibiotics has long been a matter of concern [9]. Apart from
Acinetobactor, we report emerging resistance to vancomycin among
Enterococci as a newer threat.
With dominance of MRSA strain and emergence of 3
Contributors: MPR, RG, HKC: conceived the idea of
the study; RG, IB: collected data; MPR, RG, KCA, HKC: conducted
literature review; MPR: analyzed the data. Manuscript written and
finalized by all the authors.
Funding: None; Competing interest: None
stated.
References
1. Tiwari DK, Golia S, Sangeetha KT, Vasudha CL. A
study on the bacteriological profile and antibiogram of children below
10 years in a tertiary care hospital in Bangalore, India. J Clin Diagn
Res. 2013:7:2732-5.
2. Mehta KC, Dargad RR, Borade DM, Swami OC. Burden
of antibiotic resistance in common infectious diseases: Role of
antibiotic combination therapy. J Clin Diagn Res. 2014;8:ME05-8.
3. Horan TC, Andrus M, Dudeck MA. CDC/ NHSN
surveillance definition for health care-associated infection and
criteria for specific types of infections in the acute care setting. Am
J Infect Control. 2008;36:309-32.
4. Clinical Laboratory and Standard Institute.
Performance Standards for Antimicrobial Disc Susceptibility Tests. 2005,
M100-S15. CLSI, Wayne PA.
5. Tsering D C, Chanchal L, Pal R, Kar S.
Bacteriological profile of septicemia and the risk factors in neonates
and infants in Sikkim. J Glob Infect Dis. 2011;3:42-5.
6. Prabhu K, Bhat S, Rao S. Bacteriologic profile and
antibiogram of blood culture isolates in a pediatric care unit. J Lab
Physicians. 2010;2:85-8.
7. Indian Network for Surveillance of Antimicrobial
Resistance (INSAR) group, India. Methicillin resistant Staphylococcus
aureus (MRSA) in India: Prevalence and susceptibility pattern.
Indian J Med Res. 2013;137:363-9.
8. Karunakaran R, Raja NS, Ng KP, Navaratnam P.
Etiology of blood culture isolates among patients in a multidisciplinary
teaching hospital in Kuala Lumpur. J Microbiol Immunol Infect.
2007;40:432-7.
9. Turner PJ. Meropenem activity against European
isolates: Report on the MYSTIC (Meropenem Yearly Susceptibility Test
Information Collection) 2006 results. Diagn Microbiol Infect Dis.
2008;60:185-92.
10. Indian Council of Medical Research. Standard
Operating Procedure for Antimicrobial Resistance Surveillance and
Research Network. ICMR, New Delhi, 2015.