Frequency of Blood Culture Isolates and their Antibiogram in a Teaching Hospital

  • Subha Shrestha Nepal Medical College and Teaching Hospital
  • Ritu Amatya Nepal Medical College and Teaching Hospital
  • Raj Kumari Shrestha Nepal Medical College and Teaching Hospital
  • Rajiv Shrestha Nepal Medical College and Teaching Hospital


Introduction: Bloodstream infections are associated with significant patient morbidity and mortality. Antimicrobial susceptibility patterns should guide the choice of empiric antimicrobial regimens for patients with bacteremia.

Methods:  Blood sample received from the patient attending Nepal Medical College and Teaching Hospital from March 2013 – August, 2013 were subjected to for culture. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological method

Results:  Out of the total 2,766 blood samples, 13.3% showed bacterial growth. The percentage of neonatal septicemia was 13.3%. Staphylococcus aureus (28%) was the most common isolates followed by Salmonella enterica Serotype Typhi (22%), Coagulase negative Staphylococci (9.5%), Salmonella enterica Serotype Paratyphi ((7.6%) and Klebsiella pneumoniae (7.6%). 26.3% of the isolates of Staphylococcus aureus were oxacillin resistant. Most of the gram positive organisms were susceptible to amikacin and vancomycin and showed high level resistance to cefuroxime and cotrimoxazole. Out of 109 isolates of typhoid bacilli, 95.3% were resistant to nalidixic acid ,79% to ciprofloxacin and 60.5% to ofloxacin. More than 50% of the isolates of Klebsiella pneumoniae and Escherichia coli showed resistance to  cephalosporins and cotrimoxazole. Acinetobacter spp showed high resistance (more than 60%) to ceftriaxone and ofloxacin. More than 20% of the isolates of Pseudomonas aeruginosa were resistant to ciprofloxacin and amikacin.

Conclusions:  Ongoing surveillance for antimicrobial susceptibility remains essential, and will enhance efforts to identify resistance and attempt to limit its spread.

Keywords: antibiotic; bacteria; blood stream infections.

Author Biographies

Ritu Amatya, Nepal Medical College and Teaching Hospital
Department of Microbiology, Associate Professor
Raj Kumari Shrestha, Nepal Medical College and Teaching Hospital
Department of Microbiology, Tutor
Rajiv Shrestha, Nepal Medical College and Teaching Hospital
Department of Microbiology, MD Resident


1. Bailey and Scott’s Diagnostic microbiology: A textbook for isolation and identification of pathogenic microorganisms. In 11th edition Edited by Forbes BA, Sahm DF, Weissfeld AS. St. Louis: The Mosby Company; 2002:378–422

2. Braunwald F, et al. Infectious diseases. In: Harrison TR, et al. Harrison’s Principles of Internal Medicine.14th ed. New York; McGrow-Hill 1998; P: 749-783, 2419-2420.

3. Reacher MH, Shah A,Livermore DM,Wale MC , Graham C, Johnson AP, Heine H,Monnickendam MA, Barker KF,James D.Bacteraemia and antibiotic resistance of its pathogens reported in England and Wales between 1990 and 1998: Trend Analysis. BMJ 2000; 320(7229):213-216.

4. Huang SS, Labus BJ, Samuel MC, Wan DT, Reingold AL. Antibiotic resistance patterns of bacterial isolates from blood in San Francisco County, California, 1996-1999. Emerg Infect Dis 2002 8(2):195-201

5. Friedland IR, McCracken GH. Management of infections caused by antibiotic-resistant Streptococcus Pneumoniae. N Engl J Med 1994; 331(6): 377-82.

6. Cohen ML. Epidemiological factors influencing the emergence of antimicrobial resistance, Ciba Found Symp 1997; 207: 223-231.

7. Sobhani A, Shodjai H, Khalkhali-Rad Sh. Survey on relative frequency Staphylococus resistance in samples refferred to (Razi hospital lab, Rasht, 1998). Rasht, Guilan University of Medical Sciences 1998.

8. Karunakaran R, Raja NS, Ng P K, Navaratnam P. Etiology of blood culture isolates among patients in multidisciplinary teaching hospital in Kuala Lumpur. J Microbiol Immunol Infect.2007; 40: 432-437

9. Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney Practical medical microbiology. 14th ed. London: Livingstone, 1996:131-49.

10. Clinical and Laboratory Standards Institute. Performance12 Standards for Antimicrobial Susceptibility Test. 9th ed. Approved
Standard. Wayne, PA: Clinical and Laboratory Standard Institute;
2006. (CLSI document no. M2-A9).

11. Arpi M, Victor MA, Moller JK, Jonsson V, Hansen MM, Peterslund NA,
Bruun B: Changing etiology of bacteremia in patients with hematological malignancies in Denmark. Scand J Infect Dis 1994, 26:157-162.

12. Meremikwu MM, Nwachukwu CE, Asuquo AE, Okebe JU, Utsalo SJ. Bacterial isolates from blood cultures of children with suspected septicaemia in Calabar, Nigeria. BMC Infectious Diseases 2005, 5:110

13. Pourakbari B, Sadr A, Ashtiani MTH, Mamishi S, Dehghani M, Mahmoudi S et al. Five-year evaluation of the antimicrobial susceptibility patterns of bacteria causing bloodstream infections in Iran. J Infect Dev Ctries 2012; 6(2):120-125.

14. Dagnew M, Yismaw G, Gizachew M, Gadisa A, Abebe T, Tadesse et al. Bacterial profile and antimicrobial susceptibility pattern in septicemia suspected patients attending Gondar University Hospital, Northwest Ethiopia. Dagnew et al. BMC Research Notes 2013, 6:283

15. Towns ML, Quartey SM, Weinstein MB, Reimer LG, Reller LB. The clinical significance of positive blood cultures: a prospective, multicenter evaluation. In: Abstracts of the 93rd General Meeting of the American Society for Microbiology, C-232. Washington, DC: American Society for Microbiology;1993.

16. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997;

17. Reimer LG, Wilson ML, Weinstein MP. Update on detection of bacteremia and fungemia. Clin Microbiol Rev. 1997;10:444-65.

18. Weinstein MP, Mirrett S, Van Pelt L, McKinnon M, Zimmer BL, Kloos W, et al. Clinical importance of identifying coagulase-negative staphylococci isolated from blood cultures: evaluation of MicroScan Rapid and dried overnight Grampositive panels versus a conventional reference method. J Clin Microbiol. 1998;36:2089-92.

19. Pokharel P,1 Rai SK, Karki G, Katuwal A,Vitrakoti R and Shrestha SK. Study of enteric fever and antibiogram of Salmonella isolates at a Teaching Hospital in Kathmandu Valley. Nepal Med Coll J 2009; 11(3): 176-178

20. Sharma NP, Peacock SJ, Phumratanaprapin W, Day N, White N, Pukrittayakamee S. A hospital-based study of bloodstream infections in febrile patients in Dhulikhel Hospital, Kathmandu University Teaching Hospital, Nepal. Southeast Asian J Trop Med Public Health 2006; 37: 351-6.

21. Khanal B, Sharma SK, Bhattacharya SK, Bhattarai NR, Deb M, Kanungo R. Antimicrobial susceptibility patterns of Salmonella enterica Serotype typhi in eastern Nepal. J Health Popul Nutr 2007; 25: 82-7.

22. Arora U, Devi P. Bacterial profile of blood stream infections and antibiotic resistance pattern of isolates. JK Science. 2007;9:186–90.

23. Karlowsky JA, Jones ME, Draghi DC, Thornsberry C, Sahm DF and Volturo GA. Prevalence and antimicrobial susceptibilities of bacteria isolated from blood cultures of hospitalized patients in the United States in 2002. Annals of Clinical Microbiology and Antimicrobials 2004.3:7

24. Acharya D, Bhaata DR, Malla S, Dumre SP, Adhikari N, kandel Bp.Salmonella enterica serovar Paratyphi A: an emerging cause of febrile illness in Nepal. Nepal Med Coll J 2011; 13(2): 69-73

25. Murdoch DR, Woods CW, Mark DZ et al. The etiology of febrile illness in Adults presenting to Patan Hospital in Kathmandu, Nepal. Amer J Trop Med. Hyg 2004; 70: 670-5.

26. Gupta V, Kaur J, Chander J. An increase in enteric fever cases due to Salmonella paratyphi A in and around Chandigarh.Indian J Med Res 2009; 129: 95-8.

27. Bhatia JK, Mathur AD, Arora MM. Reemergence of chloramphenicol sensitivity in enteric Fever. Med J Armed Forces India 2007; 63: 212-4.
How to Cite
Shrestha, S., Amatya, R., Shrestha, R. K., & Shrestha, R. (2014). Frequency of Blood Culture Isolates and their Antibiogram in a Teaching Hospital. Journal of Nepal Medical Association, 52(193), 692-696.
Original Article