Muhammad Saeed, Farhan Rasheed, Fouzia Ashraf, Shagufta Iram, Shahida Hussain, Abdul Rehman Khawaja.
PATHOGENS CAUSING BLOOD STREAM INFECTIONS; Cardiac patients & their susceptibility pattern from a tertiary care hospital.
Professional Med J Jan ;22(12):1617-23.

Blood stream infections (BSI) remain a major cause of debility and death around the world. BSI accounts for 10-20% of all Nosocomial infections. Empirical antimicrobials are based on the susceptibility pattern of the pathogens isolated in a specific institute from time to time. We have conducted this study only on cardiac Patients over two & half years of study duration. Study design: Cross sectional study. Settings: Microbiology Department, Allama Iqbal Medical College/Jinnah Hospital, Lahore. Study Period: January 2013 to July 2015. Materials & Methods: A total of 5411 blood culture specimens were collected from cardiac patients including patients admitted to cardiology ward, coronary care unit (CCU), pre-operative and post-operative cardiac surgery patients. The bottles containing BHI broth were incubated and were subcultured after 24 hours, 72 hours, 120 hours, and 168 hours on blood and MacConkey agars. Isolates were further identified with the help of Gram staining, biochemical reactions and rapid tests like catalase, oxidase, coagulase, Analytical Profile Index (API) 20E and API 20NE. Antimicrobial susceptibility of the isolate was carried out on Mueller-Hinton agar by Modified Kirby Bauer disc diffusion technique according to the isolate as per recommendations of Clinical and Laboratory Standards Institute (CLSI) guidelines 2013. Results: Out of total 5411 patients, 3958(73.14%) were male, 1453(26.85%) were females. Out of total 5411 Specimens, only 486 (8.98%) were positive for bacterial growth. Out of total 486 positive blood cultures, 261 (53.71%) were Gram positive isolates and 225 (46.29%) were Gram negative isolates. Out 486 positive blood cultures, 96 (19.75%) were from cardiology ward, 67 (13.78%) were from CCU, 113 (23.25%) were from pre operative cardiac surgery ward, 210 (43.20%) were from post operative cardiac surgery ward. Among Gram positives, Staphylococcus Species were most common organism isolated from 246 (50.61%) blood culture specimens. Among Gram negatives, Pseudomonas aeruginosa and E.coli were predominant organisms, isolated from 81(16.66%) and 72(14.81%) blood culture specimens respectively. Conclusion: Gram Positive isolates were more common as compared to Gram negative isolates. Vancomycin and Linezolid were the most effective drugs among Gram positive isolates. Piperacillin-Tazobactam was most potent antimicrobial against Pseudomonas aeruginosa. For coli forms Tigecycline was most effective drug.

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