Blood stream infections are important causes of morbidity and mortality in children [1]. Successful outcome of these infections relies on prompt and timely empiric therapy with broad spectrum antibiotics [2]. Inadequate empiric therapy results in poor outcome with increased mortality rate and emergence of antibiotic resistance [3]. Drug resistant organisms such as extended spectrum beta-lactamase (ESBL) producing organisms and Methicillin - resistant Staphylococcus aureus (MRSA) concern health care providers, especially in the developing countries [4]. Surveillance of prevalence and antimicrobial susceptibility of pathogens is essential for empiric treatment choice in pediatric blood stream infections. We present the distribution of pathogens and their antibiotic susceptibility profile from blood cultures in children who presented with clinical features of sepsis over a 4-year period.

All children aged between 30 days and 15 years of age, who presented to Christian Medical College, Vellore from January 2010 to December 2013 with clinical features of sepsis had their blood samples drawn under aseptic condition. The specimens were inoculated and processed by BacT/ALERT system followed by Gram staining and sub-cultures on MacConckey agar and 5% sheep blood agar. Biochemical identification of the pathogen was done using standard procedures, and followed by antibiotic susceptibility testing as per standard Clinical and Laboratory Standards Institute (CLSI) guidelines. Organisms such as Coagulase negative Staphylococcus aureus (CONS), Diphtheroids and Aerobic spore formers (ASF) were considered contaminants and excluded from analysis.

A total of 41457 blood cultures were done during the study period with positive cultures in 4.8% (n=2015); 3.6% (n=1507) Gram negative bacilli (GNB) and 1.2% (n=508) Gram positive cocci (GPC). Table I shows the predominant pathogens and their antibiotic susceptibility profile. The other pathogens were alpha-hemolytic Streptococci (n=46, 2.3%), beta-hemolytic Streptococci (n=40, 2%) and other Gram negative bacilli (n=29, 1.4%). Non-fermenting Gram-negative bacteria other than Pseudomonas spp. (NFGNB) were commonly isolated. Further characterization showed Acinetobacter spp – 202, Burkholderia cepacia – 41, Sphingobacterium multi-vorum – 6, Ralstonia spp – 4 and undifferentiated NFGNB - 269.

TABLE I Antibiotic Susceptibility Profile for the Predominant Bacteria Isolated from Blood Cultures

To conclude, we documented a high level of drug resistance in gram positive and gram negative bacterial isolates. Urgent efforts are needed to combat increasing drug-resistance in our country.

Contributors: WR and BV: study design; AP: data collection. All the authors were involved in data analysis and manuscript preparation.

Funding: None; Competing interests: None stated.

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