Bacteriological Profile of Blood Culture at a University Hospital in Mahajanga, Madagascar

Resume L’hemoculture est un examen essentiel pour detecter la presence de microorganismes dans le sang. Les objectifs de cette etude etaient d’identifier les bacteries isolees, d’etudier leurs sensibilites aux antibiotiques et de determiner le profil epidemio-clinique des patients ayant demande les hemocultures. Il s’agissait d’une etude retrospective, de type descriptive pendant 18 mois allant du decembre 2018 a juillet 2019, effectuee au laboratoire du Centre Hospitalier Universitaire Professeur Zafisaona Gabriel (CHU PZaGa) a Mahajanga. Au total, nous avons recu 126 hemocultures dont 17% de bacteriemie, 75% des resultats negatifs et 8% de contaminations. Aucune hemoculture positive a levure n’a ete trouvee. L’âge des patients variait entre 5 jours et 68 ans dont la moyenne etait 17,8 ans. Le sex-ratio etait de 0,79. Quant aux bacteriemies, les germes identifies etaient representes par 77% des bacilles a Gram negatif et 23% de cocci a Gram positif. La majorite des especes isolees etaient dominee par Enterobacter cloacae , Staphylococcus aureus , et Klebsiella pneumoniae , respectivement 31.9%, 22.8% et 18.2%. Pour les enterobacteries, aucun phenotype sauvage n’a ete identifie. L’acquisition de resistance etait representee par la production de cephalosporinase dereprimee (75%), par la secretion de penicillinase de haut niveau (12.5%) et par la production de beta-lactamase a spectre elargi (12.5%). Les 16 isolats d’enterobacteries presentaient une resistance elevee aux antibiotiques dont 100% aux aminopenicillines, 100% a l’amoxicilline associee a l’acide clavulanique, 88% aux cephalosporines de 3 eme generation,75% aux C4G, 81% a la ciprofloxacine, et 75% a la gentamicine. Tous ces isolats etaient sensibles a l’imipeneme. Pour Staphylococcus aureus , 20% presentaient un phenotype de resistance a la meticilline, mais aucune resistance a la ciprofloxacine n’a ete trouvee. L’antibiotherapie devrait etre prescrite apres tout prelevement de sang. La bacteriemie, voire la septicemie restent toujours une urgence diagnostique et therapeutique. Mots-cles : hemoculture, bacteries, antibioresistance, chu Abstract Blood culture is an essential analysis to detect the presence of microorganisms in the blood. The objectives of this study were to identify isolated bacteria, study their antibiotic sensitivities, and determine the epidemiological-clinical profile of patients who requested hemocultures. This was a retrospective, descriptive study for 18 months from December 2018 to July 2019, carried out in the laboratory of the University Hospital Centre Professor Zafisaona Gabriel (CHU PZaGa) in Mahajanga. In total, we received 126 hemocultures including 17% bacteremia, 75% of negative results and 8% of contaminations. No positive yeast hemoculture was found. Patients ranged in age from 5 days to 68 years, with an average age of 17.8 years. The sex ratio was 0.79. As for bacteremia, the identified germs were represented by 77% of Gram-negative bacilli and 23% of Gram-positive cocci. The majority of isolated species were dominated by Enterobacter cloacae , Staphylococcus aureus , and Klebsiella pneumoniae , respectively 31.9%, 22.8% and 18.2%. For enterobacteriaceae, no wild phenotypes were identified. The acquisition of resistance was represented by the production of depressed cephalosporinase (75%), by the secretion of high-level penicillinase (12.5%) and by the production of broad-spectrum beta-lactamase (12.5%). The 16 enterobacteriaceae isolates had high antibiotic resistance, including 100% to aminopenicillines, 100% to amoxicillin associated with clavulanic acid, 88% to 3rd generation cephalosporins, 75% to C4G, 81% to ciprofloxacin, and 75% to gentamicin. All of these isolates were sensitive to imipenema. For Staphylococcus aureus , 20% had a methicillin resistance phenotype, but no resistance to ciprofloxacin was found. Antibiotic therapy should be prescribed after any blood sample. Bacteremia and even sepsis are still a diagnostic and therapeutic emergency. Keywords  : blood culture, bacteria, antibioresistance, uhc