Clinical Profiles, Bloodstream Infections, and Antibacterial Susceptibility Patterns of Bacterial Isolates in a Tertiary Care Hospital: A Cross-sectional Study at Janaki Medical College Teaching Hospital, Ramdaiya, Dhanusha, Nepal

Abstract

Background: Bloodstream infections (BSIs) are among the leading causes of morbidity and mortality worldwide and are associated with prolonged hospitalization, increased health care costs, and adverse clinical outcomes. The emergence and spread of antibacterial resistance have further complicated the management of BSIs by limiting effective empirical treatment options. Knowledge of the local bacterial profiles and antibacterial susceptibility patterns is essential for guiding appropriate antibiotic therapy and strengthening antibacterial stewardship programs. This study aimed to evaluate the clinical profiles, bacterial spectrum, and antibacterial susceptibility patterns of BSIs among patients attending a tertiary care hospital in Nepal. Methods: A hospital-based prospective descriptive cross-sectional observational study was conducted at Janaki Medical College Teaching Hospital. Patients presenting to the tertiary hospital with fever for more than 3 days were evaluated. Blood culture was performed, bacterial isolates were identified, and antimicrobial susceptibility was assessed by conventional disk diffusion methods. Demographic, clinical, microbiological, and antibacterial susceptibility data were entered in Microsoft Excel 2010 and analyzed using the Statistical Package for the Social Sciences version 25. Results: A total of 200 blood culture samples were processed. Among them (35/200, 17.5%) were culture-positive. Gram-negative bacteria accounted for (28/35, 80%) of the isolates, while Gram-positive bacteria comprised (7/35, 20%). The predominant bacterial isolate was Escherichia coli (14/35, 40%), followed by Salmonella Typhi (7/35, 20%) and Staphylococcus aureus (7/35, 20%). Antibacterial susceptibility testing demonstrated the highest sensitivity to Amikacin (35/35,100%), followed by Levofloxacin (34/35, 97.14%), Piperacillin–tazobactam (30/35, 85.71%), Cefoperazone (28/35, 80.0%), Amoxicillin–Clavulanic acid (28/35, 80.0%), Ofloxacin (28/35, 80.0%), Clindamycin (26/35, 74.28%) and Azithromycin (20/35, 57.14). Lower susceptibility was observed for Ceftriaxone (16/35, 45.71%), Cefuroxime (13/35, 37.14%), and Cefepime (6/35, 17.14%), indicating relatively high resistance to cephalosporins. Fever was the presenting symptom (200/200, 100%), followed by headache (142/200, 71.0%), malaise (136/200, 68.0%), anorexia (128/200, 64.0%), nausea (69/200, 34.5%), delirium (61/200, 30.5%), and vomiting (49/200, 24.5%). Conclusion: BSIs remain a significant clinical challenge because of the increasing prevalence