Research Paper on A Profile of Bacteria Causing Septicaemia in All Military and Some Civilian Hospitals

A Profile of Bacteria Causing Septicaemia in All Military and Some Civilian Hospitals

Acknowledgement

First, I would like to express my sincere thanks to the board of Medical studies in Microbiology as well as the military and civilian hospitals that allowed me to undertake my thesis as a partial fulfillment for my degree.  I wish to express my gratitude to my professors for allowing to me undertake my studies and providing the necessary guideline in completing my study.  I also thank my supervisors for their continued advice and encouragements while carrying out my research project. 

Special thanks can also be given to the various responsible person, surgeons, physicians, and staffs in the various hospitals and the Bacteriology department of National health laboratory. I would also like to thank by friends and family for their unending support and encouragements during the period of the study.

Abstract

The paper will seek to investigate on the profile of bacteria causing septicaemia among patients in both civilian and military hospitals. Over the years, the rate of septicaemia infections has been increasingly annually. Thus, early diagnosis is needed for proper treatment using the sensitive antibiotics. 160 patients from the civilian and military were used in the sampling period of 10 months.  The examination involved blood culture and antibiotic sensitivity evaluation at a National Laboratory. The results and findings   from the study from septicaemia underlie the different disease spectrum. Therefore, the paper will ensure a detailed report of the bacteria causing septicaemia and their respective sensitivity to antimicrobial drugs.

Table of Contents

  1. Introduction ……………………………………………………………………………………5
  2. Literature review…………………………………………………………………………..….6
  3. Methodology
    1. Study population……………………………………………………………………..8
    1. Sample size…………………………………………………………………………..8
    1. Place of study…………………………………………………………………………8
    1. Materials for isolation and identification of the bacteria…………………………….10
    1.  Procedure…………………………………………………………………………….10
    1.   Collection and transportation of the blood sample…………………………………10
    1. Laboratory procedure……………………………………………………………..….10
  4. Discussion……………………………………………………………………………………11
  5. Conclusion……………………………………………………………………………………14
  6. References……………………………………………………………………………………16

Introduction

            The problem of septicaemia has developed to high levels in most civilian and military hospitals. Septicaemia explains the establishment of numerous antibiotic resistant bacteria. When a person has Septiceamia, there are various notable symptoms including chills, fever, and prostration among others. The bacteria are able to multiply in a very high rate making the human phacoptyes unable to kills the bacteria (Hu, Yu, Crosby, & Storch, 2013). It could lead to complications in various organs and tissues in the human body including heart, lung, brain, liver and bone among others. In the diagnosis of septicaemia in the humans, there are certain considerations that should be made including the approach of collection, number of the blood culture, the volume of the blood, the composition of the culture mechanism and the timing of performing the interpretation of results. This ensures that all diagnosis relating to the bacteria is made accurately. The following factors  emerges from Septicaemia that contains negative blood culture including the administration of antibiotics,  local infections, slow growth of  organisms within  the blood,  and infections to the organs that cannot be treated easily.

In seeking for the vaccinations, the scientists were able to create antibiotics using the antimicrobial drugs. The antimicrobial drugs are helpful in controlling the effects of bacterial infections in the humans. With time, the bacteria were able to develop resistance to penicillin in Staphylococcus through the generation of enzyme lactamase that reduces the needs for penicillin to serious infections. This mostly occurs to the hospitalize patients in both military and civilian hospitals. Most of the penicillin-resistant bacteria are resistant to other antimicrobial drugs including Moellering and Tetracyline among others (Chen and Hsueh, 2012). The study sought to determine profile of the bacteria causing septicaemia by establishing the prevalence of bacteria and its antibiotic resistant patterns. This would helps to prevent and control the infections from septicaemia by developing appropriate antibiotics that counters the resistance. Therefore, the details a comprehensive study on the bacteria cuasing Septicaemia patients in both civilian and military hospitals.

Literature Review

 According to Tariq (2014), Septicaemia is commonly diagnosed with the hospitalized patients.  Over the last 10 years, the prevalence of Septicaemia has increased from 10 cases to around 1000 admissions.  In some cases of septicaemia, the performance of blood culture for the bacteria is compulsory.  Scholars Chen and Hsueh (2012) found out that early treatment was relevant for the antimicrobial agents and thus, reducing the mortality rates.  Hu et al., (2013) observed that the wrong selection of antibiotics would increase the deaths of patients resulting from this condition.  The increasing amount of blood samples taken reveals that the level of septicaemia detected increases respectively.  The collection of blood among adults is acceptable, but an increased blood culture bottle makes it more expensive to perform the medical procedure. Children contain the highest level of bacteria circulation and thus, they needs low blood samples.

 Zakariya, Bhat, Harish, Babu and Joseph (2011) investigated the main sources of septicaemia in the human body. He found that the bacteria emanates from the urinary tract respiratory tract and skin infections including wounds and cellulitis. The rate at which a bacterium causes an infection in the human body depends on the rate of invasion of the blood.   This differs in the various bacteria that cause infection in the human bodies. For instance, close to 90 per cent of the infection cases are caused by Haemophilus influenza and Salmonella, with minimal cases cased by Shigella, and Jejuni. Apart from the various infections options, the bacteria can also result from microbial growth within the inner surfaces of the human body.  Some etiologic agents include the Viridans streptococci. According to a study by Hu et al., (2013), urinary tract infections cover close to 42 per cent of the reported cases of Septicaemia among hospital patients.  In the study, it was discovered that the pathogens related to the various infections includes “Staphylococcus aureus, Klebisella, Pseudomonas, Escherichia coli and group A Strepococci”(Ghadiri, Vaez, Khosravi, & Soleymani, 2012).

The bacterium that causes Septicaemia has various characteristics. First, the Staphylococcus species can be differentiated from streptococci due to their production of enzyme that breaks hydrogen peroxide (Tariq, 2014). The Staphylococcus aureus assists in the production of coagulase that allows for action on fibrinogen acting as a clumping agent. In addition, the Staphylocccus epididermis is obtained from the coagulase negative Staphylococcus organisms. It usually accounts for close to 75 per cent of all patients isolated in the hospitals.  In contrast to the Staphylococcus aureus, they produce few viruses due to their ability to develop adherent biofilms on the implant surfaces (Zakariya et al., 2011).

In addition, the Streppocic is elaborate with various enzymes and extracellular devices. They usually contain three responses towards the blood agar.  The streptococci can be differentiated in the culture types by their ability to communicate and engage the human body. The enteroccus is also a relevant aspect of the bacteria reported by Chen and Hsueh (2012), as the third pathogen that is popular in human blood.  The various gram negative bacteria include the enterobactiaceae that causes the Septicaemia infections.  Blood culture is a medical procedure relevant for detecting bacteria in the human body.  The reliability of blood cultures depends on the number of bacteria as well as the volume of the blood in circulation. Therefore, the above medical literature helps to provide the history and comprehensive description of the bacteria causing Septicaemia among the patients (Hu et al., 2013).

Methodology

The research methodology will use a sample population in conducting the appropriate study. The nature of the study was a hospital based descriptive study.

Materials Needed

 Study population

The study was only performed to the hospitalized patients who showed the signs and symptoms of septocaemia.  Some of the signs and symptoms followed include fever and chills among others.  However, all HIV-infected patients were excluded from the study.

 Sample Size

From the entire population, 160 patients from the various civilians and military hospitals were eligible for the study. The sampling period was 10 months.

Place of study

The study was to be conducted in the National Health laboratory.

 Materials for Isolation and Identification of the bacteria

  1. Culture media.   These includes
  • Aerobic broth: Glucose broth media.
  • Anaerobic broth: Thioglycollate broth
  • Media for biochemical identification of isolated organisms

These materials include lactose, glucose, mannitol, sucrose, urea, citrae, motility agar, and gelatin.

  1. Blood culture bottles

The blood culture bottles comprises of a glass material with a volume close to 100ml containing metal screw caps.

 Procedure in using the blood culture bottles

  1. Collect the specimens using the blood culture bottles.
  2.  Isolate and identify the organisms using the test tubes, sterile petridishes, pipettes, cover slips and the glass slides.
  3.  Perform sensitivity testing using a sterile bijou bottle.
  4. Other equipments

These include autoclave, refrigerator, microscope, anaerobic jar and incubator among others.

  • Reagents

The reagents are useful for the morphological and biochemical evaluation of the bacteria. They includes gram straining reagents, hydrogen peroxide acts as a catalyst,  methyl red reagent,  1% TMPD for oxidation test,  Kovac’s reagent and the potassium hydroxide and alpha naphthol. The reagents are significance in identifying the bacteria.

Methods

 Selection of the participants

 The study was  performed using inpatients that comprise of the signs and symptoms of septicaemia as identified by the  medical officers.

Procedure

First, an assistant is needed to control the tourniquet that collects a blood sample from the patients. The antecubital are washed well to avoid the contamination of the blood samples.  The tourniquet is then applied.  The syringe is removed from the sterile tube with any personal contact and around 5ml of blood is drawn from the vein.  The tourniquet is then released and pressure applied to stop any bleeding.  The contents in the syringe are put into the bottle ready for transportation (Ghadiri et al., 2012).

Collection and Transportation of the blood sample

It is recommendable that the blood should be collected before the taking of antibiotics.  Regular antibiotic therapies are required after the blood sample is collected for culture. In the study, the entire blood sample was taken before the administration of the antibiotics.

Laboratory Procedure

The blood culture bottles are placed in the laboratory within two hours where they are incubated at 37-Celsius degrees. However, the procedure differs between the aerobic and anaerobic organisms. After one day of incubation, the plates are examined for colonial morphology.  In Anaerobic, it takes two days to examine the strict anaerobic bacteria. All media are inspected for their continued growth and development.  If there are any suspected pathogens, they would be isolated using the stoke method.

Discussion

From the findings of the study, septicaemea is a common inflection among patients in hospitals. The diseases require early detection, diagnosis, and using the correct antibiotics.  The infection can occur in the various ways in the human body.  In the current study within the 10 months, the 160 samples collected from the patients relates to different clinical conditions. Among the 160, the bacteria causing septicaemia was detected in 49 cases that surrounds close to 30 .92 per cent of the entire cases. As it can be seen from table 1, obstetrics, and gynecological situations were common causes of septicaemia. With six cases of cardiovascular diseases, five patients had the pyrexia condition, five patients with malignancy cases and four with respiratory tract infection.  The urinary tract and other related aspects were three infections. Two of the cases were related to hematopoietic disease and the remaining was attributable to diabetes.

 In the study, the bacteria involved in septicaemia were found to be the negative bacteria commonly present in the pathogens.  Thus, the findings of the study correlates with past studies that revealed that serious septicaemia infections were caused by gram-negative bacteria from a study conducted in UK hospitals.  The factor that increases the infections among the hospitalized patients includes the use of steroid therapy, antimetabolite drugs and the immunosuppressive agents.  The finds of the study also   found out 17 Acinetobacter elements isolated from patients with septicaemia. This relates to the congestive cardiac failure, diabetes, incomplete abortion, and hepablastoma.  However, two strains of Acinetobacter were separated from the ill patients with certain internal devices. 

When blood culture was performed on patient form a military hospital with anaemia,   Acinetobacter calcoaceticus was discovered and isolated. It is found to be resistant to most of the drugs. In the Defenses Services hospital, close to 80 per cent of the extensive burn case were infected by Acinebacter species, which was resistant to the various drugs, used on the patient.  In addition, some patient was isolated with Staphylococcus aureus. 9 were separated from the Defences Services Hospitals. The nature of the antibiotics sensitivity towards Staphylococcus aures implies that 11 of the total 15 cases were resistant to the penicillin treatment. It was expected because Staphylococcus aureus produce enzyme penicillinase.  There were 15 strains towards Tetracyline, in which four were determined to be resistant.

Table 1: Bacteria isolated from Obstetrics and Gynaecology cases (OG) causing septicaemia

  Diagnosis Types of isolate Number of Isolates
1 2 3 4 5 6 7   Acinetobacter species Acinetobacter species Acinetobacter species Acinetobacter species Acinetobacter species Acinetobacter species Staphylococcus aureus 1 1 1 1 1 1 1
    Total isolates 7

Table 2. Antibiotic sensitivity pattern of Acinetobacter species from CVA cases causing septicaemia

No. Types of isolate Number of isolate A S C T G Ci
1 Acinetobacter 1 R S S S S S
2 Acinetobacter 1 R S S S S S

A= Ampicillin                                     S=Septrin                                C=Chloramphenicol

T=Tetracycline                                    G=Gentamycin                       Ci=Ciprofloxacin

Table 3: Antibiotic sensitivity pattern of gram positive bacteria causing septicaemia

No. Types Number of Isolate P Ox E S T C Cx A G Ci
1   2     3 Staphylococcus aureus Streptococcus faccalis Strept. peumoniae 2 1 1     1 R S S – S S S – R S S- S S S R S S S R S S S – – – – R – – – R – – – S – – – s

Table 4:  Bacteria isolated from septicaemia associated with PUO

No/ Number of  cases Predisposing condition  
1. 2. 3. Pseudomonas aeruginosa Pseudomonas maltophilia Acinetobacter In dwelling catheter Intra vascular  
Total 5    

Fig. 5 Number of Bacteria isolated associated with septicaemia

 Fig. 6 A graph showing the bacteria isolated from 49 cases of septicaemia

Conclusion

            According to the findings of the study, close to 49 organisms were obtained from the total 160 case samples from the various civilians and military hospitals.  The blood samples of the patients were scientifically investigated at a national laboratory. The study found out that the causing organisms followed a certain order as follows from the highest number of bacteria isolated to the lowest. They include Staphylococcus aureus, Pseudomonas species, Klebsiella pneumonia, Staphylococcus epididermis, Streptococcus pneumonia, Streptococcus faecalis, Escherichia coli, Coliform and Citrobacter. Staphylococcus through the generation of enzyme lactamase that reduces the needs for penicillin to serious infections. This mostly occurs to the hospitalize patients in both military and civilian hospitals.

Some of the various bacteria can be seen to be resistant to the antimicrobial drugs provided.  For instance, Acinetobacter was observed to the resistant to Ampicillin and Gentamycin, but it respondent to the other drugs. Staphylococcus was isolated in two case of septicaemia obtained in national laboratory from civilian hospitals. The Staphylococcus aureus assists in the production of coagulase that allows for action on fibrinogen acting as a clumping agent.  In the case of Pseudomonas, it was noted isolated from any hospital, but it was sensate to the drugs including Ampicillin, Ceftrazidine, and Piperacillin. In addition, Staphylococcus epiderdermis is isolated with eh medic al wards among the military hospitals. The bacteria were sensitive to Tetracyline and Chloramphenicol in both the military and civilian hospitals.  Both Streptococcus faecalis and Citrobacter were discovered from the military hospitals. They were sensitive towards Gentamycin, Ciprofloxacin, and Septrin.

The study was performed using the blood specimens from the various wards in both the civilian and military hospitals. This helped to provide crucial information on the prevalence and incidence of the bacteria causing septicaemia. The collection of blood among adults is acceptable, but an increased blood culture bottle makes it more expensive to perform the medical procedure. The identification of bacteria depends on improved diagnosis and clinical management of the patients. It is significant to explain to the involved clinicians of the findings in order to ensure coordination and multidisciplinary efforts in tackling the growth of the resistant bacteria. However, it can only be done through reducing the abuse of antibiotics which common amongst the various patients. As seen from the study, each hospital requires infection control programs to implement the antibiotic policy. The study is significant, as it shows the dynamic nature of the nosocomial pathogens and their resistant profile towards the different anti-microbial drugs. Therefore, the findings suggest that there should be strict use of antibiotics in order to control the disease caused by bacteria.

References

Chen, Y. H., & Hsueh, P. R. (2012). Changing bacteriology of abdominal and surgical sepsis. Current opinion in infectious diseases, 25(5), 590-595.

Ghadiri, H., Vaez, H., Khosravi, S., & Soleymani, E. (2012). The antibiotic resistance profiles of bacterial strains isolated from patients with hospital-acquired bloodstream and urinary tract infections. Critical care research and practice, 2012.

Hu, X., Yu, J., Crosby, S. D., & Storch, G. A. (2013). Gene expression profiles in febrile children with defined viral and bacterial infection. Proceedings of the National Academy of Sciences, 110(31), 12792-12797.

Tariq, T. M. (2014). Bacteriologic profile and antibiogram of blood culture isolates from a children’s hospital in Kabul. Journal of the College of Physicians and Surgeons Pakistan, 24(6), 396-399.

Zakariya, B. P., Bhat, V., Harish, B. N., Babu, T. A., & Joseph, N. M. (2011). Neonatal sepsis in a tertiary care hospital in South India: bacteriological profile and antibiotic sensitivity pattern. The Indian Journal of Pediatrics, 78(4), 413-417.