Study on Bacteremia in Hemodialytic Patients and Antibiotics Susceptibility Pattern

Abstract

Background: Bacteremia is the presence of bacteria in the blood stream. Because hemodialysis patients are immunocompromised, bacterial blood stream infection is the most common cause of death. In hemodialytic patients, blood stream infections are mainly due to Gram-positive cocci. Patients undergoing hemodialysis are especially vulnerable if the infection is caused by Staphylococcus aureus that accounts more than 8% mortality rate.  Methods: A cross-sectional study was carried out at National Kidney Center of Nepal for duration of six months. Blood samples were collected from the individuals undergoing hemodialysis treatment. The collected blood samples were inoculated in brain heart infusion (BHI) biphasic medium in a blood culture bottle and incubated aerobically at 37°c for 18-24 hours (up to 1 week if necessary). It was then sub-cultured on blood agar plate where colony morphology and hemolytic reactions were observed. In order to identify the isolate organisms, a series of biochemical assays were performed. The modified Kirby Bauer technique was used to conduct the antimicrobial susceptibility test. The SPSS software was used to record and evaluate all the data collected. Results: The study comprised of a total of hundred patients. Gram-positive bacteria were found to have highest frequency (61.5%). Gram-positive bacteria such as Staphylococcus aureus (26.9%) and CoNS (88.4%) were isolated in high frequency, as were Gram-negative bacteria such as Escherichia coli (3.8%), Klebsiella pneumoniae (3.8%), and Pseudomonas aeruginosa (3.8%) were also isolated. Staphylococcus aureus was shown to be the most prevalent Gram-positive isolate among hemodialysis patients. Most of these S. aureus strains were reported to be amoxicillin resistant but cefoxitin sensitive Methicillin resistance was detected in 37.5% of the 16 S. aureus isolates. For most Gram-positive bacteria, amoxicillin was shown to be the least effective drug, whereas ciprofloxacin was found to the most effective. Conclusion: The purpose of the study is to understand the prevalence of bacteria in hemodialytic patients as well as the antibiogram of the isolates as it is the first to study about bloodstream infections in hemodialytic patients in Nepal. These results might provide a foundation to explore more about bacteriological infection study in hemodialytic patients and antibiogram.