Aspiration in Head and Neck Cancer Patients: A Single Centre Experience of Clinical Profile, Bacterial Isolates and Antibiotic Sensitivity Pattern

Abstract

Most patients with head and neck cancer have dysphagia and are at increased risk of having aspiration and subsequent pneumonia. It can cause prolonged hospitalization, treatment delay and/or interruption and mortality in cancer patients. The treatment of these infections often relies on empirical antibiotics based on local microbiology and antibiotic sensitivity patterns. The aim of present study is to analyse respiratory tract pathogens isolated by sputum culture in head and neck cancer patients undergoing treatment at a tertiary cancer centre in South India who presented with features of aspiration. The study is carried out to establish empirical antibiotic policy for head and neck cancer patients who present with features of aspiration. This was a retrospective study. The study included sputum samples sent for culture and sensitivity from January 2011 to December 2012. Analysis of microbiologic species isolated in sputum specimen and the antibiotic sensitivity pattern of the bacterial isolates was performed. A detailed study of case files of all patients was done to find out which is the most common site prone for producing aspiration. There were 47 (31.54 %) gram positive isolates and 102 (68.45 %) gram negative isolates. The most common bacterial isolates were Klebsiella pneumoniae (25.50 %), Pseudomonas aeruginosa (16.77 %) and Haemophilus influenzae (15.43 %). Levofloxacin was the most effective antibiotic with excellent activity against both gram positive and gram negative isolates. Most patients with aspiration had laryngeal cancer (34.89 %). Aspiration pneumonia was present in 14 (9.39 %) patients. Gram negative bacteria are common etiologic agents in head and neck cancer patients presenting with features of aspiration. Levofloxacin should be started as empirical antibiotic in these patients while awaiting sputum culture sensitivity report. As aspiration in head and neck cancer is an underreported event such institutional antibiotic sensitivity studies should be encouraged for prompt initiation of antibiotic that is most likely to be effective against etiologic pathogens.

Occurrence of influenza and bacterial infections in cancer patients receiving radiotherapy in Ghana

“…Results from this current study also indicate a significant association of ARI with HNC and this could be due to the location of the cancer since HNC mostly affect the upper airways serving as an effective barrier to infection [ 44 – 46 ]. Also, most of the HNC patients reported with advanced cancers at clinical stages III and IV, putting them at increased risk of a more compromised immune system hence susceptible to infections including ARI [ 47 , 48 ].…”

Medidas de prevenção da progressão da disfagia em pacientes com câncer de cabeça e pescoço submetidos a radioterapia: uma revisão sistemática com meta-análise

“…Adicionalmente às alterações musculares, a RT, dependendo da região irradiada, pode promover diferentes graus de alteração da sensibilidade, paladar, fluxo salivar e edema laríngeo (26) . Separadamente ou em conjunto estes efeitos afetam o processo de deglutição levando à repercussões sistêmicas significativas, capazes de influenciar negativamente na adesão ao tratamento oncológico (27) , o quê, por sua vez, torna necessário a implementação de intervenções multidisciplinares profiláticas (28,29) .…”

Preventive measures for the progression of dysphagia in patients with cancer of head and neck subjected to radiotherapy: a systematic review with meta-analysis

“…In addition to the muscle alterations, depending on the irradiated region, RT may promote different degrees of alteration in sensitivity, taste, salivary flow, and laryngeal swelling (26) . Either individually or combined, these effects affect the swallowing process leading to significant systemic repercussions that can negatively influence the adherence to the cancer treatment (27) , which, in turn, requires the deployment of multidisciplinary prophylactic interventions (28,29) .…”