Bacteriological Diversity and Antibiogram Analysis of Blood Culture Isolates in a Pediatric Setting at Tertiary Care Hospital Karachi

Abstract: Background: In low-middle income countries multi-drug resistant (MDR) bacteria are considered a health priority. The protocols directed by The Clinical and Laboratory Standards Institute (CLSI) recommend to develop antibiogram in hospital settings. Objective: To analyze the bacteriological diversity and antibiogram patterns of blood culture isolates in a pediatric settings at a tertiary care hospital in Karachi, Pakistan. Materials and Methods: This descriptive cross-sectional study was executed at Department of Pediatrics, Liaquat National Hospital during 2nd February, 2025 to 30th September, 2025 after taking formal ethical approval of the hospital committee bearing number App#1152-2024-LNH-ERC. Patients admitted to pediatric department and suspected for blood stream infection (BSI) were included. Standard aseptic measures were used to collect the blood sample. According to the CLSI's breakpoint guidelines, the isolates were classified as susceptible, intermediate, or resistant to the test antibiotics bases on inhibition zone diameter. Result: A total of 370 patients were enrolled with median age of patients was 35.5 (IQR=12-124) months. BSI was detected in 75 (20%). Out of 75, gram-positive and gram-negative bacteria were found in 17 (22.7%) and 58 (77.3%) patients respectively. Out of total 17 gram positive bacteria, almost half were Streptococcus pneumoniae and other half were Enterococcus species. Among 58 gram-negative bacteria, the commonest detected pathogen was Salmonella Typhi (56.9%). Among gram-positive bacteria, both of pathogens were 100% resistant to meropenem. Resistance of Ciprofloxacin, Ceftriaxone, Cefuroxime was seen in 100% isolates of Klebsiella pneumoniae, E. coli and Hafnia alvei. S. Typhi was least resistant to Cefuroxime (3%), Chloramphenicol (3%) Gentamicin (6%), Imipenem (6%) while highly resistant to Ceftriaxone (75.8%), Ampicillin (72.7%), Amikacin (69.6%). Conclusion: A remarkable burden of BSI was found in our settings with higher burden of gram-negative bacteria, Enteric fever being the most frequent. Different resistance patterns were observed for different antibiotics, mostly 100% resistance was seen for most of bacterial isolates. This finding underscores the ongoing monitoring of antimicrobial profile to decide the appropriate empirical therapy of antibiotics. Keywords: Antibiogram, Antimicrobial profile, Antibiotics, Blood stream infections, Low-middle income countries.