Date: 10/10/2012
Place: Bellary.
From:
DR. CHHAYA R. BAJANTRI
Post Graduate Student in Microbiology (M.D)
Dept. of Microbiology,
VIMS, Bellary.
To:
The Principal,
Vijayanagar Institute of Medical sciences,
Bellary.
THROUGH PROPER CHANNEL
Respected Sir,
SUBJECT: SUBMISSION OF SYNOPSIS FOR REGISTRATION
OF SUBJECT FOR DISSERTATION
In accordance with fulfillment of the MD Microbiology course, I, the undersigned studying PG course in M.D. Microbiology have been allotted the dissertation topic “STUDY OF AEROBIC BACTERIOLOGICAL PROFILE OF BLOOD STREAM INFECTIONS IN PAEDIATRIC AGE GROUP AND ANTIBIOTIC SUSCEPTIBILITY” UNDER THE GUIDANCE OF DR KRISHNA. S Professor and Head of department, Department of Microbiology, Vijayanagar Institute of Medical Sciences, Bellary.
I request you to kindly forward the synopsis in the prescribed form to the University for approval.
Thanking you,
Yours faithfully,
(Dr. Chhaya R. Bajantri)
Signature of the guide
Dr. KRISHNA. S.
Professor & HOD
Dept. of Microbiology
VIMS, Bellary.
Place: Bellary
Date: 10/10/2012
From:
The Professor and Head,
Dept. of Microbiology,
Vijayanagar Institute of Medical Sciences,
Bellary-583104.
To:
The Registrar,
Rajiv Gandhi University of Health sciences,
Bangalore-560041.
THROUGH PROPER CHANNEL
Respected Sir,
SUBJECT: SUBMISSION OF SYNOPSIS FOR REGISTRATION
OF SUBJECT FOR DISSERTATION
As per the regulations of the University for Dissertation topic, the following post graduate student in M.D Microbiology has been allotted the dissertation topic as follows:-
NAME / TOPIC / GUIDEDr. CHHAYA R. BAJANTRI
Post Graduate Student in M.D. Microbiology,
Dept of Microbiology,
VIMS, Bellary. / “STUDY OF AEROBIC BACTERIOLOGICAL PROFILE OF BLOOD STREAM INFECTIONS IN PAEDIATRIC AGE GROUP AND ANTIBIOTIC SUSCEPTIBILITY.” / Dr KRISHNA. S.
Professor & HOD
Dept. of Microbiology
V.I.M.S, Bellary.
Therefore, I kindly request you to communicate after the acceptance of the dissertation topic allotted to the PG student at an early date.
Thanking you,
Yours faithfully,
DR. KRISHNA.S
Professor and Head,
Dept. of Microbiology,
VIMS, Bellary.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE
ANNEXURE-II
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. /Name of the candidate AND ADDRESS
/ dr. CHHAYA R. BAJANTRIPOST GRADUATE STUDENT IN
M.D. MICROBIOLOGY,
DEPARTMENT OF
MICROBIOLOGY,
VIMS, BELLARY.
2. / NAME OF THE INSTITUTION / Vijayanagar Institute Of Medical Sciences, Bellary.
3. / Course of Study and Subject / MEDICAL
M.D. MICROBIOLOGY
4. / DATE OF ADMISSION TO THE COURSE / 16th September 2013
5. / TITLE OF THE TOPIC
“STUDY OF AEROBIC BACTERIOLOGICAL PROFILE OF BLOOD STREAM INFECTIONS IN PAEDIATRIC AGE GROUP AND ANTIBIOTIC SUSCEPTIBILITY.”
6. / BRIEF RESUME OF THE INTENDED WORK:
Nosocomial blood stream infections (BSI) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. The crude mortality is high particularly for critically ill patients. In the ICU setting children with BSI had crude mortality rates of 52% in Israeli hospital and 14% in a multicentre study of US hospitals.1.
Variety of both Gram positive & Gram negative bacteria are recovered from blood stream. Over the past several decades there has been clear shift in the nature of infective flora. Number of aerobic isolates has decreased over the time and clinically significant coagulase negative staphylococci have increased.2.
Patients who are debilitated, immunodeficient, immunocompromised are at high risk because of circulating bacteria may not be cleared from blood for hours.2.
Most health facilities lack the resources for doing microbiological studies, so the data on invasive bacterial infections are very limited. The local incidence of infections such as meningitis and pneumonia has been estimated, often in relation to vaccine studies. However, there are almost no incidences, mortality, or hospital burden for the majority of pathogenic bacterial species. Most data are from a few urban referral centers with very little recent data from rural areas.3
6.2 / REVIEW OF LITERATURES.
In a study done by Rahul Pradhan, Umesh Shreshta, Sameer C Gautam etal 1084 febrile childrens under the age of 15 were enrolled. Of the total 649(60%), were male and 227(21%) had reported taking antibiotics within 48 hours before presentation, over the entire study period upper respiratory tract infection and enteric fever were the most common initial clinical diagnosis. Enteric fever was most common initial diagnosis in summer and respiratory tract infection in winter.4
Another study done by MELVIN .P. microorganisms that almost always (>90% of isolates) represent true infections when isolated from the blood include staphylococcus aureus, E.coli and other Enterobacteriacea, P.aeruginosa, S.pnemuoniae and candida albicans.5 .
In a study of Murthy D S’ and Gyaneshweri 220 samples from 107 children were processed.Cultures positivity rate was found to be highest in neonates(52.63%),risk factors were identified in 35%.administration of empirical antibiotics was already initiated by the time of collection of sample in 66.35%of cases,of these only 8% had positive cultures with delayed culture growth .The duration of incubation of broth(24,48,72hrs and 7days),after which positive cultures were obtained on plating was also noted. None of the cultures were positive on broth beyond 72hrs.Almost all the isolates were sensitive to cephalosporins and amikacin.6
In a study by Carlos Alberto Pires Pereira, Alexander R Marra etal a total of 2563 cases of nosocomial blood stream infections, 342 clinically significant episodes of BSI were identified in pediatric patients. 96% of BSI were monomicrobial. Gram negative organisms caused 49%, Gram positive caused42.6% & fungi caused 8.4%. The most common pathogens were CONS(21.3%) Klebsiella spp(15.7%) Staph aureus(9.2%) 45% occurred in PICU/NICU.1
In a study by James A,. Berkely,M.D. of 1933 patients blood cultures from 2769 (14.3%) grew CONS (1526 patients) bacillus (1162), micrococcus (52), viridians streptococci (29).3
6.3 / OBJECTIVES OF THE STUDY :
1 .To identify the causative aerobic bacteria from the blood samples.
2. To identify the risk factors causing aerobic blood stream infections.
3. To know the antibiotic susceptibility pattern of the isolates.
7. / MATERIALS AND METHODS :
7.1 / SOURCE OF DATA: The study will be conducted in department of microbiology in association with department of pediatrics.
STUDY PERIOD:1ST JANUARY -31ST DECEMBER2014 or 100 samples whichever is earliest
STUDY DESIGN: Prospective study
INCLUSION CRITERIA:
1 Patients aged 0-14 years.
2. Blood samples of suspected septicemia.
EXCLUSION CRITERIA:
1. Drawing samples from intravascular devices.
2. Blood culture readings after 7 days.
3. Anaerobic study.
7.2 / METHODS OF COLLECTION OF DATA :
The Data of patients regarding the Name, age, sex, address, duration of febrile condition, nutritional history, immunization history, duration of antibiotic coverage, and labor history in case of neonates, will be taken.
Blood samples for culture will be collected following aseptic precautions. For infants and children, 1-5 ml of blood is drawn for blood culture. Two blood samples will be drawn an hour apart. Blood samples will be drawn before antibiotic therapy. If empirical antibiotics were already started, the collection is timed before the next dose of antibiotic. Three sets will be collected in cases of suspected or sonographically diagnosed congenital heart disease.
Immediately after collection the blood will be inoculated into brain heart infusion broth without switching needles. The bottles containing 10ml of BHI broth will be used in case of neonates and 50ml will be in other children to allow 1:10dilution.
The culture bottles will be incubated at 37 0 C aerobically. After overnight incubation, the samples will be sub cultured onto blood agar, MacConkey’s agar and chocolate agar. If there is no growth observed on the plates by the next day, subcultures will be again repeated from the broth on day 3 and day 4, finally on day 7.If there is any growth it will be identified and antibiotic susceptibility tests will be performed by agar disk diffusion method of Kirby bauer according to CLSI guidelines.
Statistical analysis: Statistical analysis will be done using appropriate formula and P value is calculated.
7.3 / DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
IF SO, PLEASE DESCRIBE BRIEFLY.
YES. Routine investigations will be done in each patient participating in our study. Written or informed consent will be obtained from each patient before subjecting them for investigations. All the investigations will be done under the direct guidance and supervision of guide.
7.4 / HAS THE ETHICAL CLEARANCE OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Ethical clearance has been obtained from institutional ethics committee, VIMS, Bellary.
8. / LIST OF REFERENCES :
1.Carlas Alberto Pires Pereria, Alexander R. Morra et al “Nosocomial blood stream infections in Brazilian pediatric patients : Microbiology, Epidemiology and clinical features” PLOS 2013(8) 7 July 4 doi :10,13711/journal
2.Washington Winn J R, Stephen Allen, William Jonda, Elwea Koneman, Gary Procop, Paul Schreckenberger, Gail Woods Infections of Blood 6th ed 2006 Koneman’s Color Atlas and Textbook of Microbiology p100-105
.3.James Berkely M D, Bretl S et al “Bacteremia among children admitted to rural hospital at Kenya” NEJM ,Med.2005 ; 352 :39 ; 47/ January 6 2005/ doi;10,1056/NEJM Mou 040275
4.Rahul Pradhan, Umesha Shrestha et al 2012 “Blood stream infections among children presenting to General Hospital Outpatient Clinic in Urban Nepal PLOS ONE 7(10) ; e 47531 doi 10,1371/journal.pone.0047531
5.Melvin P Weinstin, Robert wood Johnson et al “Current blood culture methods and systems : Clinical concepts, technology and interpretation of results” Clinical Infectious Diseases 1996; 23 ; 40-6
6.Murthy D S and Gyaneshwari M et al “Blood cultures in pediatric patients : A study of clinical impact. Indian J Med Microbiol 2007 ; 25 : 220-4
7.L K Siu, Pollang L U, et al “Bacteremia due to extended spectrum beta lactamases producing E. coli & Klebsiella Pneumoniae in pediatrics” Journal of Clinical Microbiology Dec 1999 p 4020-4027
8.Vivian Rosardo, Robertam de C et al Infection, central venous catheters, surveillance Jornal de Pediatrica (Rio J). 2011 ; 87(6) : 469-77
9.Hany Aly M D, Victor Herson M D et al “Is blood stream infection preventable among premature infants” Pediatrics Vol 115 No. 6 June 2005 p 1513-1518
10.Anil Sachdev, Dhiren Gupta et al “Central Venous Catheter Colonization in PICU Indian Pediatrics 2002 ; 39 : 752-760
11.Belty A. Farbes, Daniel F. Sahm, Alice S. Weissfeild, Bailey & Scott’s Diagnostic Microbiology 12th ed Mosby Elsevier Publications p 785-794
12.J. G. Collee, A. G. Fraser, B. P. Marmion, A. Simmons Editors Mackie & McCartney Practical Medical Microbiology 14th ed p 121-124
9. / SIGNATURE OF THE CANDIDATE
10 / REMARKS OF THE GUIDE :
11 / NAME AND DESIGNATION OF (IN BLOCK LETTERS) :
11.1 / GUIDE: / DR.KRISHNA.S ,
PROFESSOR AND HOD,
DEPT. OF MICROBIOLOGY,
VIMS, BELLARY.
11.2 / SIGNATURE :
11.3 / CO-GUIDE (IF ANY) :
11.4 / SIGNATURE :
11.5 / HEAD OF THE
DEPARTMENT : / DR. KRISHNA.S
PROFESSOR AND HEAD,
DEPT. OF MICROBIOLOGY,
VIMS, BELLARY
11.6 / SIGNATURE :
12 / 12.1 / REMARKS OF THE
CHAIRMAN AND
PRINCIPAL :
12.2 / SIGNATURE :