BLOODSTREAM INFECTIONS AND ANTIMICROBIAL PROFILE IN PEDIATRIC PATIENTS WITH ASSOCIATED RISK FACTORS IN A TERTIARY CARE HOSPITAL

Abstract

Background- Blood stream infections are very common (up to 20–50 %.) in the pediatric age group in developing countries. The choice of empirical antimicrobial requires the knowledge of the epidemiology of common pathogens which constantly changes necessitating periodic review to their sensitivity prole to formulate an antibiotic policy. This Method- retrospective observational cross sectional study was conducted in Tezpur Medical College & Hospital, Tezpur, Assam from October 2020 to September 2021 among 138 samples from Pediatric cases (Day one to 14 yrs of age) with clinically suspected sepsis. Out of 138 studied blood sample Result- s 36% (50/138) were culture positive. Out of 50 positive cases, 45(90%) of were in Neonatal group and 5(10%) were the non-neonatal group .Isolates were Gram positive cocci 56% (28/50), Gram negative bacilli 36% (18/50) and Candida albicans 8% (4/50). Isolates were Staphylococcus aureus 50% (25/50), Klebsiella pneumoniae 26% (13/50), Acinetobacter species 8% (4/50), Enterococcus species 4% (2/50), Coagulase negative Staphylococci 2% (1/50) and Escherichia coli 2% (1/50). S. aureus were sensitive to Vancomycin 100%, Linezolid 84%, Clindamycin 80%, Gentamicin 60%, Amikacin 60%, Cotrimoxazole 44%, Doxycycline 44% and Ampicillin 24%. MRSA among S. aureus was 28% (7/25). Only one of the isolates of CoNS, 1/2 (50%) was resistant to Ampicillin, Cotrimoxazole and Doxycycline whereas it showed 100% sensitive to vancomycin, Linezolid, Clindamycin, Gentamicin and Amikacin., All Gram positive isolates in this study were 100% sensitive to vancomycin. Klebsiella pneumoniae were found to be resistant to Cefuroxime 100%, but susceptible to meropenem 100% and imepenem 100% followed by amikacin 77%, gentamycin 69%. All of Gram-negative bacilli were susceptible to meropenem and imipenem. Maternal risk factors were PROM (Premature rupture of membrane) 17(37.7%), MSAF ( Meconium stained amniotic uid) 15 (33.3%), Prolonged labour12 (26.6%) and UTI 6(13.3%). Maternal febrile illness3(6.6%) and foul smelling liquor 3(6.6%). Among neonatal risk factors low birth weight 26(57.7%), Prematurity (42.2%), Perinatal asphyxia 17(37.7%) and Mechanical ventilation 3(6,6%). Patients were presented with refusal to feed 46.6% (21) ,Jaundice37.7% (17) Respiratory distress31.1% (14) and Convulsion28.8% (13). - S. aureus and Klebsiella pneumoniae, were the leading cause of pediatric se Conclusion psis and resistant to multiple antibiotics. Risk factors identied were Premature Rupture of Membrane, Meconium Stained Amniotic uid, Prolonged labour, LBW , Prematurity and Perinatal asphyxia .Commonest presentation were Refusal to feed, Jaundice and Respiratory distress.