PP1 - Bacterial pathogens & their antibiotic susceptibility pattern of community-acquired bacteremia in adult diabetic patients at a Base Hospital in Gampaha District Sri Lanka

Abstract

Introduction

Poorly controlled diabetes increases the risk of bacteremia and sepsis, causing high morbidity and mortality if untreated. Antibiotic resistance varies geographically, making it essential to understand local susceptibility patterns for effective patient care.

 Objectives

To assess the causative bacterial pathogens, antibiotic susceptibility, and related 30-day mortality in community-acquired bacteremia in adult diabetic patients at a base hospital (BH) in Gampaha District, Sri Lanka.

 Methodology

A hospital-based, prospective, descriptive, cross-sectional study was conducted at BH Wathupitiwala from November 21, 2022, to March 20, 2023. Blood cultures were collected from all adult diabetic patients admitted to medical and surgical wards with suspected or documented infections who met qSOFA criteria within 48 hours of hospital admission and before starting antibiotics. Data were gathered using an interviewer-administered questionnaire and structured record sheets. Blood cultures were processed manually or using the BACT/ALERT automated system. Identification and antibiotic susceptibility testing were done according to standard operating procedures for positive cultures. Data analysis was performed using SPSS version 26.

 Results

Among 129 eligible patients, 28 (21.7%) had significant positive blood cultures. Blood cultures that did not yield a positive result after 5 days of incubation were considered negative (n=101). The most common pathogens were Enterobacterales (n = 20, 71%) and Staphylococcus aureus (n = 6, 21.4%). The main focus was urinary tract infections (n=19, 67.8%), followed by skin and soft tissue infections (n=7, 25%) and respiratory infections (n=7, 25%). A significant association between blood culture positivity among diabetic patients with UTI was noted (OR:3.8; 95% CI: 1.56 – 9.29; p=.002). Extended-spectrum beta-lactamases (ESBL) producers comprised (n=9)45% of Enterobacterales.  All Enterobacterales were 100% sensitive to carbapenems and amikacin. All S. aureus isolates, including MRSA (n=4,11%), were 100% sensitive to vancomycin, teicoplanin, and linezolid. The 30-day mortality rate among diabetic bacteremia patients was 28.5%. (n=8).

 Conclusion

Among the studied adult diabetic patients, community-acquired bacteremia was predominantly caused by Enterobacterales, with urinary tract infection identified as the primary source. A notably high rate of ESBL-producing Enterobacterales was observed. The 30-day mortality was 28.5%. Prompt initiation of effective antibiotics after blood culture collection in suspected sepsis patients is crucial.