Etiological Structure and In Vitro Susceptibility to Antimicrobial Agents from Blood Cultures in Bulgarian Multi profile Hospital, 2015-2016

During the period 2015-2016, a total of 1490 haemocultures were tested, 24.4% of which were positive. Among the 363 isolated microbial agents, 224 (62% or 15% of all) were considered clinically significant with equal distribution of Gram-positive (48.2%) and Gram-negative bacteria (47.8%). This finding differs from European
and US practice where Gram positive bacteria are dominant. Fungi were isolated in 4%. The etiological structure was as follows:Coagulase Negative Staphylococcus – 20.1%, E. coli - 14.3%, Enterococcus spp. - 14.3%, Klebsiella spp. - 11.2%, S. aureus - 10.3%, Acinetobacter baumannii - 9.4%, Enterobacter spp. - 5.8%, P. aeruginosa – 4.9%. A trend toward increase of Klebsiella spp, E.coli, S. aureus и Candida spp. and decrease of coagulase-negative Staphylococci, Enterococcus spp. and Acinetobacter baumannii was observed. Regarding “ESKAPE” pathogens – we had a similar rate of Enterococci, and lower rates for the rest compared to USA practice, but in contrast to European data we had lower rate of S. aureus, similar rates of Enterobacter and P. aeruginosa, and higher rates of Enterococci, Klebsiella and Acinetobacter. Multidrug resistance was found in 11% of Gram positive and 47% of Gram negative flora. Resistance rates were similar to the European, but higher in Gram negative and lower in Gram positive when compared to USA. Owing to failure of the other approaches we introduced a stronger stewardship and restrictive policy regarding prescription of antibiotics.