The Prevalence of Bacteremia among Patients Admitted to a Military Hospital in Alkharj

Aim: The aim of this study is to determine the prevalence of bacteremia among patients admitted to a military hospital in Alkharj and to know the causative organisms. Methodology: Bacteria culture results were collected from the laboratory of the military hospital after the approval of the study by IRB ethical committee. The data were collected and analyzed using Excel spreadsheet 2016 and the descriptive data were represented as frequencies (n) and percentages (%). Results: The total number of positive blood culture were 131 cultures, about 53.44% of the causative bacteria were gram positive bacteria. Generally, a high percentage of bacteremia was caused by Staphylococcus species, especially Coagulase-negative staphylococcus (25.19%) and Staphylococcus aureus (22.90%). Conclusion: It can be concluded that the incidence of bloodstream infection in the present study is high and that the most common causative pathogens were Coagulase-negative staphylococcus Original Research Article Ahmed et al.; JPRI, 32(30): 93-99, 2020; Article no.JPRI.62482 94 and Staphylococcus aureus. It is important to know the incidence of bloodstream infection and to know the causative organisms both for clinical practice, especially to evaluate the effectiveness of interventions and also for research activities.


INTRODUCTION
Bacteria are living things that have only one cell. Most bacteria are harmless and less than 1 % of the different types lead to infection. Only infectious bacteria can cause illness. Many of these bacteria give off toxins, which can harm tissue and cause sickness such as Staphylococcus, Escherichia coli and Streptococcus [1].
Bacteremia is defined as the existence of viable bacteria in the circulating blood. These bacteria are usually cleared from the blood within minutes, but if the immune system of the patient is weak, microbes persist in the blood and results in bacteremia associated symptoms [2]. Bacteremia is a common problem that is associated with major morbidity and mortality globally [3][4][5][6][7][8][9][10].
Kim et al reported that the rate of bloodstream infections was high in patients admitted to long term care hospitals (20.4%) [11]. Goto et al reported that in North America and Europe, bacteremia is one of the top seven reasons of death [12].
There are several factors affect the epidemiology of bacteremia including shifts in healthcare, advances in medicine such as increased use of intravascular devices, invasive procedures, use of immunosuppressive treatment and changing with ageing of the people [13].
Numerous bacteria cause bacteremia, Staphylococcus aureus is the most common gram-positive organism causes bacteremia, while Escherichia coli is the most common cause of gram-negative associated bacteremia [14][15][16].
It is important to know the epidemiology of bacteremia in order to assess its impact on public health; additionally it is important to know the causative organisms of bacteremia in order to guide the health care workers in treating bacteremia appropriately. Therefore, the aim of this study is to determine the prevalence of bacteremia among patients admitted to a military hospital in Alkharj and to know the causative organisms.

METHODOLOGY
In this retrospective study, we included all bacterial cultures of patients of all age groups (children, adults or elderly patients) that were collected from blood in 2018 and 2019. So the exclusion criteria included other types of cultures such as wound, urine cultures. Moreover, the cultures that were collected before 2018 or after 2019 were excluded. The study was conducted in a military hospital in Alkharj that was established in 1983 to contribute to health and well-being of military and civilian employees of ministry of defense and their dependents.
Bacteria culture results were collected from the laboratory of the military hospital after the approval of the study by IRB ethical committee. The data included prevalence of bacteremia in 2018 and 2019 in addition to percentage of gram positive and gram negative organisms that cause bacteremia.
The data were collected and analyzed using Excel sheet 2016 and the descriptive data were represented as frequencies (n) and percentages (%).

RESULTS
In 2018, there are 75 positive blood cultures; the majority of them were gram positive. Number and percentage of gram positive and gram negative bacteria that cause bacteremia in 2018 are shown in Table 1.   Table 3.  Table 4.
The total number of positive blood culture were 131 cultures, about 53.44% of the causative bacteria were gram positive bacteria. The total number and percentage of gram positive and negative bacteria that cause bacteremia in 2 years are shown in Table 5.
Generally, a high percentage of bacteremia was caused by Staphylococcus species, especially Coagulase-negative staphylococcus (25.19%) and Staphylococcus aureus (22.90%). The total number and percentage of different bacteria that cause bacteremia in the 2 years were shown in Table 6 and in Fig. 1.

DISCUSSIONS
In 2018, there are 75 positive blood cultures out of 747 cultures (10.04%); the majority of them were gram positive. About 44% of the bacteremia cases were caused by Coagulasenegative staphylococcus followed by Pseudomonas aeruginosa and Staphylococcus aureus.
In 2019, there were 56 positive blood cultures out of total 992 cultures (5.64%). Nearly, 53.57% of these cultures were gram negative bacteria. About 37.5% of the causative bacteria in 2019 were Staphylococcus aureus bacteria followed by Escherichia coli and Klebsiella pneumonia.   [25].
Regarding gram negative bacteria, P. aeruginosa was the most common cause of bacteremia followed by Escherichia coli and Klebsiella pneumonia. In contrast to that, several studies showed that Klebsiella pneumoniae is the second most common cause (after Escherichia coli) of community-and hospital-acquired Gramnegative bloodstream infection [8,22,26].

Fig. 1. The percentages of different bacteria that cause bacteremia
The hospital started the implementation of several interventions to decrease the rate of infections caused by bacteria or other microorganisms such as using masks and hand hygiene in addition to the implementation of infection control guidelines and policies.
One of the limitations of this study was that the available results were not divided according to the age because the incidence and the causative organism differ between adult, children or elderly. Moreover, there was no available data about specific factors about the patients such as if the patient has comorbidities or chronic diseases and also the diagnosis was not written in the cultures' results.

CONCLUSION
It can be concluded that the incidence of bloodstream infection in the present study is high compared to other studies and that the most common causative pathogens were Coagulasenegative staphylococcus and Staphylococcus aureus. It is important to know the incidence of bloodstream infection and to know the causative organisms both for clinical practice, especially to evaluate the effectiveness of interventions and also for research activities.

CONSENT
As per international standard or university standard, patient's consent has been collected and preserved by the authors.

ETHICAL APPROVAL
As per international standard or university standard written approval of the study by IRB ethical committee has been collected and preserved by the author(s).