Bacterial Spectrum and Antimicrobial Resistance Pattern in Cancer Patients with Febrile Neutropenia

Abstract

Background:Bacterial bloodstream infections are one of the most common complications in cancer patients under treatment. Bacteremia in these patients is a medical crisis that needs antibiotic treatment. The aim of this study was to determine bacterial spectrum and antimicrobial resistance pattern in febrile neutropenic cancer patients.Methods:In this prospective study, 212 cancer patients with febrile neutropenia who were referred to Shahid Sadoughi hospital in Yazd from 2012 to 2015 were participated. Bacterial pathogens isolated by the BACTEC media and antimicrobial susceptibility tests performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines.Results:The mean age of patients was 43.5 ± 24.98 years old. Out of 212 participants, 62.3℅ (132/212) were suffering from hematologic malignancies, and 37.7℅ (80/212) had solid tumors. Gram-negative bacteria were the predominant microorganisms (84.9℅). E.coli was the most frequently isolated pathogen (38.68 %), followed by Klebsiella (14.15℅) and Acinetobacter species (11.32℅). In addition, Staphylococcus epidermidis was the most common isolated Gram-positive bacteria (8.5℅). Gram-negative bacteria were susceptible to ciprofloxacin with a response range of 53.7% to 100%. The majority of E.coli isolates were sensitive to ceftazidime (87.8℅) and were resistance to Co-trimoxazole (15.8℅). Klebsiella isolates were 100% susceptible to cephalosporins, meropenem and imipenem.Conclusion:The majority of bacterial pathogens were resistance to various antibiotics. Judicious use of antibiotic therapy can prevent the emergence and spread of antibiotic-resistant Gram-negative bacteria.

Current spectrum of causative pathogens in sepsis: A prospective nationwide cohort study in Japan

“…Among the 1352 isolated causative pathogens in adult sepsis in this study, the dominant pathogens were E. coli, K. pneumoniae, and MSSA. A number of previous studies have reported E. coli to be the most frequent pathogen in patients with severe infectious diseases (Vahedian-Ardakani et al, 2019;Mehl et al, 2017;Todorovic Markovic et al, 2019). In addition, several studies have reported S. aureus as the most frequently isolated of the grampositive pathogens (Vahedian-Ardakani et al, 2019;Todorovic Markovic et al, 2019).…”

“…In contrast, E. coli was associated with significantly lower mortality in the present study. One possible explanation for the high survivability is that the E. coli were generally susceptible to many common antimicrobial agents including ciprofloxacin, gentamicin, trimethoprim-sulfamethoxazole, cephalosporins, and carbapenems (Vahedian-Ardakani et al, 2019;Guerra et al, 2003;Trecarichi and Tumbarello, 2014). Therefore, based on these insights, we are now planning another study to evaluate the twoway association between causative pathogen, types of antimicrobials used, and survival.…”

Isolat Bakteri pada Surveilans Bakterial dan Demam Neutropenia pada Pasien Leukemia Akut Dewasa di Rumah Sakit Cipto Mangunkusumo

“…5 Infeksi yang berhubungan dengan demam neutropenia tidak hanya berhubungan dengan mortalitas yang tingi, tetapi juga lama perawatan yang panjang dan biaya yang besar. [6][7][8] Terlebih angka kejadian demam neutropenia yang tinggi yaitu mencapai 96% pada pasien yang mendapatkan kemoterapi agresif selama fase induksi, dengan angka respons lengkap (complete response rate) pertama (pasca induksi) sebesar 90%. 9 Untuk itu, pemberian antibiotik empirik dengan segera sangatlah penting.…”

“…Selain itu, ketersediaan data yang akurat tentang organisme patogen kausatif juga penting dalam menentukan terapi empirik untuk menurunkan angka kematian dan mencapai tujuan pengobatan. 6 Surveilans bakterial merupakan prosedur yang rutin untuk setiap pasien dengan leukemia akut sebelum menjalani kemoterapi agresif. Tujuan dari pemeriksaan ini adalah untuk mendapatkan data mengenai patogen komensal yang dapat membantu menuntun klinisi (ahli hematologi) untuk memberikan terapi antimikrobial yang tepat ketika pasien mengalami demam neutropenia.…”

“…Walaupun ditemukan 103 isolat dari kultur darah, pola kepekaan (sensitivitas) dari isolat tersebut terhadap antibiotik spesifik yang direkomendasikan oleh ESMO atau IDSA yang diadopsi oleh PPRA, yaitu golongan sefalosporin anti-pseudomonas seperti seftazidim, sefepim, imipenem, meropenem, atau piperasilin-tazobaktam, tidak dapat dianalisis. 6,12,13 Adanya bakteri gram positif yang paling banyak ditemukan pada surveilans bakterial pasien leukemia akut yang menjalani kemoterapi intensif atau mengalami demam neutropenia, dan tidak didapatkan MRSA selama periode tersebut, maka diperlukan data yang lebih baru/ terkini. Namun, karena adanya renovasi ruang rawat isolasi lantai 8 Gedung A sejak tahun 2015 hingga 2020, data surveilans bakterial terbaru belum dapat diperoleh.…”