Microbiological profile of bloodstream infections and antimicrobial resistance patterns at a tertiary referral hospital in Amazon, Brazil

ABSTRACT Background: Bloodstream infections (BSI) are a global health issue, leading to high mortality and morbidity among hospitalized patients. Methods: A retrospective, observational and descriptive study was conducted by reviewing blood culture records collected from patients with suspected BSI, between January 2017 and December 2019. Results: The most frequent antimicrobial resistant (AMR) pathogens were methicillin-resistantStaphylococcus aureus(MRSA) (40%), methicillin-resistantS. epidermidis (MRSE) (9.5%), and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (35.3%). Conclusions: Our findings underscore the importance of continued vigilance and advocate for the rational use of antimicrobial agents.


Study design
1* Specimen types: Describe the types of specimen included, i.e. clinical (e.g.blood cultures) or non-diagnostic surveillance (e.g.admission and other screening swabs to diagnose carriage).If specimens were obtained for diagnostic reasons, clinical syndromes should be described where possible, and specimens / isolates stratified by clinical syndrome.Yes 4

9*
Antimicrobial susceptibility testing: Describe the antimicrobial susceptibility testing methods used, internal quality control processes, and their interpretation, with reference to a recognised international standard -e.g.CLSI, EUCAST.Where an international standard was followed, the specific edition(s) of guidelines used should be referenced.Deviations from standard methodology should be described, along with evidence of validation.Handling of any changes to interpretative criteria during the sampling period should be documented.State whether the raw AST data (zone diameters and / or minimum inhibitory concentrations) were re-categorised with updated breakpoints or left as-is.

Yes 4 10
Additional tests performed to identify resistance mechanisms: Describe the testing methods used for adjunctive / confirmatory antimicrobial susceptibility tests, such as enzymatic / molecular assays (e.g.Xpert MTB / RIF, mecA PCR) and inducible resistance assays, with reference to a recognised international standard, where available.
Where an international standard was followed, the specific edition of guidelines used should be referenced.Deviations from standard methodology should be described, along with evidence of validation.

19 Reporting multidrug resistance proportions:
(8) strategy for accounting for duplicate and sequential isolates from the same patient should be clearly detailed.Duplicate isolates are multiple isolates of the same phenotypic organism (i.e.same species and same resistance profile) from the same patient on the same date cultured either from the same clinical specimen, or from two separate clinical specimens, such as blood and CSF.Sequential isolates are isolates of the same phenotypic organism from the same patient at different dates, such as blood cultures taken on different dates.Various strategies for the handling of duplicate and sequential isolates exist(8), and the strategy used should be transparent as it will bias pooled resistance results.For example, inclusion of all isolates (the 'all isolate strategy'), has been shown to shift pooled resistance proportions toward greater resistance, whilst inclusion of only the first isolate per patient (the 'first isolate strategy') or only the first isolate per infection episode (the 'episode-based strategy') will shift pooled results towards susceptibility.If defined, the proportion of MDR isolates should be expressed as the number of MDR isolates out of the number of isolates tested (i.e. the number undergoing the MDR test panel specific to that organism).Single agent / class resistance should be always be reported, regardless of MDR reporting.why bias may have been introduced into the reported data, due to patient / specimen selection, isolation of organisms, or otherwise.Consider factors which may have either introduced bias into the types of organisms isolated or the antimicrobial susceptibility profiles, e.g.receipt of antimicrobials prior to specimen collection will reduce the yield of certain species and also select for more resistant organisms.
No 13Accreditation: State whether the laboratory is accredited through a national or international body (e.g. the International Standards Organisation, ISO) and specify which NA assays are covered in the accreditation.