Analysis of blood stream infections, antibiograms and clinical outcomes in haematological patients with febrile neutropenia: data from a tertiary care haematology institute in India

Ghosh, Shouriyo; Chakraborty, Moumita; Samanta, Sujay; Sinha, Nilanjan; Saha, Sandeep; Chattopadhyay, Arnab; Roy, Siddhartha Sankar; Bhattacharyya, Maitreyee

doi:10.1007/s00277-020-04324-8

Cited by 14 publications

(10 citation statements)

References 24 publications

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“…Among the isolated pathogens, the general frequency of MDR was 50,9% (28/55). The main isolated MDR bacteria were E. coli and K. pneumoniae, which present results in agreement with other studies 49,41 . The detection of ESBL resistance genes was 73,7%, presenting data similar to those found by other studies in this same population of cancer patients.…”

Section: Discussionsupporting

confidence: 92%

“…The epidemiology of the occurrence of bacteremia in cancer patients has changed over time and has been characterized by a change in the pro le from gramnegative bacteria (1960s to 1970s) to gram-positive bacteria (1980s). Gram-negative bacteria have been predominant as the main agents of bloodstream infections in cancer patients in the last two decades on the global stage 40,41 .…”

Section: Discussionmentioning

confidence: 99%

“…BGNs showed greater resistance to aminopenicillins, fourth generation cephalosporins, uoroquinolones, second and rst generation cephalosporins and aminoglycosides, in agreement with the results of a study in India carried out with 66 cases of bloodstream infection 40 . Increased resistance to carbapenems, combinations of beta-lactamase inhibitors, beta-lactamase, aminoglycosides, uoroquinolones and cephalosporins (including high resistance to cefepime) has been observed 41 .…”

Section: Discussionmentioning

confidence: 99%

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Epidemiological Profile and Detection of Resistance Genes in Bloodstream Infection in Cancer Patients: High Occurrence of Metallo-β-lactamases in Enterobacteriales

Soares

Inácio

Silva³

et al. 2021

Preprint

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Bloodstream infections remain one of the most common major complications in cancer patients. The aim of the study was to describe the etiology, phenotypic and molecular epidemiology of ICS isolates from cancer patients. Method: identification and the resistance profile were carried out using the automated biochemical method Vitek 2®. The presence and genes resistant to carbapenemases blaIMP, blaVIM, blaGIM, blaSIM, blaSPM, blaKPC, blaNDM, genes oxacilinase blaOXA-48, blaOXA-58, and the presence of ESBL genes blaSHV, blaCTX, blaTEM for Gram-negatives, as well as, mecA, vanA and vanB for Gram-positives were investigated in blood culture isolates. Result: Escherichia coli and Klebsiella pneumoniae were the most frequent pathogens. The serine-β-lactamase gene blaOXA-48 was the most frequent, followed by MβL blaSIM. blaTEM and blaCTX were the most common among ESBL. The mecA and vanA genes were found in Staphylococcus spp. and Enterococcus faecium, respectively. Candida spp showed high resistance to voriconazole and fluconazole. Conclusion: measures to prevent and control the spread of resistance genes are essential to reduce the risks of morbidity and mortality.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Epidemiological Profile and Detection of Resistance Genes in Bloodstream Infection in Cancer Patients: High Occurrence of Metallo-β-lactamases in Enterobacteriales

Soares

Inácio

Silva³

et al. 2021

Preprint

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“…29,30 Our findings of lower incidence of GPB isolates are similar to the previously published data of 20-25% GPB isolates from the Indian subcontinent. 10,31 The probable explanation for this is a lack of fluoroquinolone prophylaxis and breach in the gut barrier following anthracycline-based chemotherapy. [32][33][34][35] B cepacia and A baumannii were the most common organisms in our study.…”

Section: Discussionmentioning

confidence: 99%

The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

Mishra

Kumar

Ninawe

et al. 2021

Therapeutic Advances in Infection

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Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days ( p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 ( p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.

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“…Despite stringent preventive measures and emphatical use of antibiotics neutropenic sepsis carries a high mortality which can range from 2-21 % (33) and is higher in adults compared to children (34). Ghosh S et al, has shown a mortality rate of 19.5% in an Indian study running over one year (35). They have used single-agent cefepime or piperacillin-tazobactam/tigecycline combination as empirical agents.…”

Section: Discussionmentioning

confidence: 99%

Adapting Supportive Care Guidelines from High-income Countries; Real World Data on Approach to Neutropenic Sepsis in Haemato-Oncology Patients in Sri Lanka

Hewamana

Skandarajah

Jayasinghe

et al. 2021

Preprint

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BackgroundSepsis is the main cause of non-relapse mortality and there are no published data on applicability of supportive care protocols from high-income countries in Sri Lanka. The aim of the study was to investigate management and mortality of neutropenic episodes among Haemato-Oncology patients. MethodsWe analysed retrospectively clinical characteristics, management, morbidity and mortality of neutropenic adult Haemato-Oncology patients from 01.01.2019 to 31.12.2019. ResultsA total of 169 neutropenic episodes were identified; 115 (68%) of such episodes were related to chemotherapy. Acute leukaemia, Lymphoproliferative disorders and Plasma cell disorders accounted for 23%, 69% and 8% of patients respectively. The median age of patients who had sepsis was 56 while that of those who had no sepsis was 53 (p-value 0.49). Median time to neutropenia was 9 days for those in the sepsis group compared to 8 days in the group that had no sepsis (0.64). Median neutrophil count in the group who had sepsis was 0.06 while it was 0.69 in the group that had no sepsis (p-value 0.000). Median time to commencement of antibiotics was 20 minutes. There were no deaths in the group of chemotherapy induced neutropenic sepsis. ConclusionThis is the only documented study relating to outcome and successful applicability of western supportive care protocols to Sri Lankan patients with neutropenia. In this study we have shown that survival data comparable to developed countries can be achieved in the setting of limited resources with service development, following guidelines and staff training.

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Analysis of blood stream infections, antibiograms and clinical outcomes in haematological patients with febrile neutropenia: data from a tertiary care haematology institute in India

Cited by 14 publications

References 24 publications

Epidemiological Profile and Detection of Resistance Genes in Bloodstream Infection in Cancer Patients: High Occurrence of Metallo-β-lactamases in Enterobacteriales

Epidemiological Profile and Detection of Resistance Genes in Bloodstream Infection in Cancer Patients: High Occurrence of Metallo-β-lactamases in Enterobacteriales

The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

Adapting Supportive Care Guidelines from High-income Countries; Real World Data on Approach to Neutropenic Sepsis in Haemato-Oncology Patients in Sri Lanka

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