Blood stream infection (BSI) is a critical clinic situation that requires immediate diagnosis and treatment. In this study, we aimed to determine the BSI pathogens among the patients who admitted to emergency medicine clinic (EC). A retrospective surveillance study was conducted to evaluate the results of blood culture of the emergency patients in a university hospital between January 2015 and December 2017. Total 4569 blood culture were performed between the study period, and 802 (17.5%) of them yielded positive result, of which 14 (1.7%) were fungi, and remaining 788 (98.3%) were bacteria. Except the coagulase-negative staphylococci (CNSs) which was the major contaminant of blood cultures; Escherichia coli (n: 170; 21.2%) was the most frequently isolated organisms in this survey, and this was followed by Klebsiella spp. (n: 55; 6.8%) and Staphylococcus aureus (n: 54; 6.7%). The frequency of extended spectrum beta-lactamases (ESBLs) among the members of Enterobacteriaceae was measured as 38.2%, and the methicillin resistance of S. aureus was 7.4%. The common community acquired bacteremia agents were detected as relatively less, in such an order as Streptococcus pneumoniae (n: 14; 1.7%), beta-hemolytic streptococci (n: 11; 1.3%), and Brucella spp. (n: 7; 0.8%). This study indicates that gram negative enteric bacteria are the most frequent pathogens of BSI, and the high antimicrobial resistance mediated by ESBL resistance poses a substantial therapeutic problem in our region. The results also suggest that S. pneumoniae seems to be circulating in the community despite the vaccination campaigns. Emergency departments are critical units to diagnose community-acquired bacteremia and to commence appropriate antimicrobial chemotherapy for the patients with BSI.
___
Jawad I, Lukšić I, Rafnsson SB. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality. J Glob Health. 2012;2(1):010404.
Büke Ç. Yeni rehberler eşliğinde sepsis. Available at: http://www.klimik.org. tr/wp-content/uploads/2015/06/Yeni-Rehberler-E%C5%9Fli%C4%9FindeSepsis-%C3%87a%C4%9Fr%C4%B1-B%C3%9CKE.pdf. accessed date 20.12.2017
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):136877.
van Engelen TSR, Wiersinga WJ, Scicluna BP, et al. Biomarkers in sepsis. Crit Care Clin. 2018;34(1):139-52.
Perman SM, Goyal M, Gaieski DF. Initial emergency department diagnosis and management of adult patients with severe sepsis and septic shock. Scand J Trauma Resusc Emerg Med 2012;27(20): 41.
European Committee on Antimicrobial Susceptibility Testing. Clinical Breakpoints for Bacteria, V.7.1. EUCAST. Sweden, 2017.
Micek ST, Hampton N, Kollef M. Risk factors and outcomes for ineffective empiric treatment of sepsis caused by gram-negative pathogens: stratification by onset of infection. Antimicrob Agents Chemother. 2017;62(1):pii:e01577-17.
Virzì GM, Clementi A, Brocca A, et al. Endotoxin effects on cardiac and renal functions and cardiorenal syndromes. Blood Purif. 2017;44(4):314-26.
Stasi A, Intini A, Divella C, et al. Emerging role of lipopolysaccharide binding protein in sepsis-induced acute kidney injury. Nephrol Dial Transplant. 2017;32:24–31. 1
Fujishima S. Organ dysfunction as a new standard for defining sepsis. Inflamm Regen. 2016;36:24.
Prescott HC, Costa DK. Improving long-term outcomes after sepsis. Crit Care Clin. 2018;34(1):175-88.
Young LS. Sepsis syndrome. In: Mandell GL, Bennett JE, Dolin R Eds., Principles and Practice of Infectious Diseases. Fifth Ed. Churchill Livingstone, New York, 2000;806-19.
National Institute for Health and Care Excellence. Sepsis: recognition, assessment, and early management. NICE Guideline 51. Royal Collage of Physicians. 2016.
Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546-54.
Rupp ME, Fey PD. Extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment. Drugs. 2003;63(4):353-65.
Diekema DJ, Beekmann SE, Chapin KC, et al. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J Clin Microbiol. 2003;41(8):3655-60.
Buetti N, Marschall J, Atkinson A, et al, Swiss Centre for Antibiotic Resistance (ANRESIS). National bloodstream infection surveillance in Switzerland 2008-2014: different patterns and trends for university and community hospitals. Infect Control Hosp Epidemiol. 2016;37(9):1060-7.
Esel D, Doganay M, Alp E, et al. Prospective evaluation of blood cultures in a Turkish university hospital: epidemiology, microbiology and patient outcome. Clin Microbiol Infect. 2003;9(10):1038-44.
Burnham JP, Kwon JH, Olsen MA, et al. Readmissions with multidrugresistant infection in patients with prior multidrug resistant infection. Infect Control Hosp Epidemiol. 2017;17:1-8.
Hoenigl M, Wagner J, Raggam RB, et al. Characteristics of hospital-acquired and community-onset blood stream infections, South-East Austria. PLoS One. 2014;9(8):e104702.
Bolat F, Uslu S, Bolat G, et al. Healthcare-associated infections in a Neonatal Intensive Care Unit in Turkey. Indian Pediatr. 2012;49(12):951-7.