Epidemiology of bloodstream infection in Saudi Arabia

Bloodstream infections are a challenge to clinicians due to high rates of morbidity and mortality. Moreover, rational antimicrobial therapy, if promptly started, can improve the prognosis of sepsis. The gold-standard blood culture has some limitations and it takes time to complete (about 2-5 days). This leaves the clinicians to start immediately broad-range antimicrobial therapy until microbiology culture’s results available that may lead to complicate situation of patient further. Therefore, there is an urgent need for the development of more advanced diagnostic approaches that can overcome limitations of culture-based methods. This review gives an overview of the BSIs and its epidemiology over several cities and hospitals in Saudi Arabia. It also encompasses the diverse molecular diagnostic modalities developed for the rapid detection and identification of BSIs. Furthermore, the growing understanding of the host’s inflammatory responses to infections has led to the discovery of immunological biomarkers as diagnostic tools for sepsis-related BSI. The rational use of immunological and molecular diagnostic markers in clinical settings may speed up diagnosis and prognosis of septic patients. This review shows that the percentage of BSIs in Saudi Arabia, from 1983 to 2015, ranges from 1% to 11% among patients with confirmed infection. It also indicated that Staphylococcus aureus and coagulase negative staphylococci (CoNS) were the most common Gram-positive pathogens; while Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most Gram-negative ones from patients with BSI. The recommendation of this review is to initiate new surveillance systems of BSI in different regions and hospitals in Saudi Arabia and determining the antibiotic susceptibility profile to design antibiograms that may improve the antibiotic stewardship program for treating BSIs. A comparative study should be conducted for patients suspected to have sepsis, using the standard blood cultures, immunological markers and rapid molecular assays to set up a panel to help diagnose BSIs rapidly. This will allow early and optimal patient management and treatment in Saudi Arabia and therefore decrease overall healthcare costs.