Tackling antibiotic resistance in febrile neutropenia: current challenges with and recommendations for managing infections with resistant Gram-negative organisms

Nouér, Simone Aranha; Nucci, Márcio; Anaissie, Elias

doi:10.1586/17474086.2015.1060576

Cited by 18 publications

(13 citation statements)

References 82 publications

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“…An earlier study in Uganda also found that of the patients who sought treatment at private clinics within 1 week of onset of symptoms, only 7% of them were properly managed. [16][17][18][19][20][21][22] Similar findings have been documented in Ghana where a high proportion, 70% of the respondents, practiced self-medication, and the most common antibiotic used was amoxicillin. 23 It is noted that the majority of drug shops (53.3%), were injecting patients probably with gentamicin and penicillin, to treat other bacterial infections like skin infections and urethritis or urinary tract infections.…”

Section: Discussionsupporting

confidence: 77%

Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda

et al. 2016

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ObjectivesThe main objective of this study was to assess practices of antibiotic prescription at registered drug shops with a focus on upper respiratory tract infections among children in order to provide data for policy discussions aimed at improving quality of care and patient safety in the private health sector in Uganda.MethodsA survey was conducted within 57 parishes from August to October 2014 in Mukono District, Uganda. Data was captured on the following variables: drug shop characteristics, training of staff in management of pneumonia, availability of guidelines and basic equipment, available antibiotics, knowledge on treatment of pneumonia in children aged <5 years. The main study outcome was the proportion of private health facilities prescribing an antibiotic.ResultsA total of 170 registered drug shops were surveyed between August and October 2014. The majority of drug shops, 93.5% were prescribing antibiotics, especially amoxicillin and trimethoprim-sulfamethoxazole (septrin). The professional qualification of a provider was significantly associated with this practice, p=0.04; where lower cadre staff (nursing assistants and enrolled nurses) overprescribed antibiotics. A third, 29.4% of drug shop providers reported that antibiotics were the first-line treatment for children with diarrhoea; yet the standard guideline is to give oral rehydration salts and zinc tablets. Only few providers, 8.2%, had training on antibiotics, with 10.6% on pneumonia case management. Further to this, 7.1% drug shops had WHO-Integrated Management of Childhood Illness guidelines, and a negligible proportion (<1%) had respiratory timers and baby weighing scales. Although the majority of providers, 82.4%, knew severe signs and symptoms of pneumonia, few, 17.6%, knew that amoxicillin was the first-line drug for treatment of pneumonia in children according to the guidelines.ConclusionsThere is urgent need to regulate drug shop practices of prescribing and selling antibiotics, for the safety of patients seeking care at these outlets.

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Section: Discussionsupporting

confidence: 77%

Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda

et al. 2016

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“…Broad spectrum antibiotics given as treatment or prophylaxis exert selection pressure leading to the survival of resistant strains of bacteria, particularly in the gut. 36 Some of the limitations of this study were as follows: (1) Speciation of microbial isolates could not be performed as conventional methods of microbial identification were used. (2) Anaerobic blood culture was not done owing to infrastructure-related issues.…”

Section: Discussionmentioning

confidence: 99%

“…Broad spectrum antibiotics given as treatment or prophylaxis exert selection pressure leading to the survival of resistant strains of bacteria, particularly in the gut. 36 …”

Section: Discussionmentioning

confidence: 99%

Microbiological Profile of Blood Stream Infections in Febrile Neutropenic Patients at a Tertiary Care Teaching Hospital in Rishikesh, Uttarakhand

et al. 2020

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Context Febrile neutropenia is a serious complication of chemotherapy affecting patients with both hematological and solid malignancies, respectively. To the best of our knowledge, there is paucity of literature from Uttarakhand, India on microbiological profile of blood stream infections (BSIs) in febrile neutropenic patients. Aims The study aims to generate preliminary data on microbiological profile and antibiotic resistance pattern of BSIs in febrile neutropenic patients. Settings and Design The design involved cross-sectional study from January 1, 2019 to July 31, 2019. Methods and Materials Data of nonrepetitive paired peripheral blood samples obtained from 306 consecutive febrile neutropenic cancer patients of all age groups and both sexes, for culture and sensitivity testing, were retrospectively analyzed. All blood samples were subjected to aerobic culture using BACT/ALERT three-dimensional microbial detection system. Growth obtained in culture was identified by conventional biochemical methods. Antibiotic susceptibility testing of bacterial isolates was performed using modified Kirby Bauer disk diffusion method. Statistical Analysis Used Fisher’s exact test was used for the analysis. Results Mean age ± SD of the study population was 32.39 ± 10.56 years with a male to female ratio of 1.55:1. 74.18% of the blood samples were received from patients suffering from hematological malignancies. Microbiologically confirmed BSIs were observed in 27.1% patients. Gram-negative bacilli were predominantly isolated in culture with Klebsiella spp. being the most common. Percentage resistance values of gram-negative bacilli to aminoglycosides, β-lactam/β-lactamase inhibitor combinations, fluoroquinolones, cephalosporins, carbapenems, chloramphenicol, ampicillin, co-trimoxazole, and doxycycline were 26.6 to 91.7%, 8.3 to 86.6%, 10 to 66.7%, 13.3 to 73.3%, 8.3 to 73.3%, 80 to 93.3%, 13.3 to 20%, 16.7 to 66.6%, and 13.3 to 16.7%, respectively. Conclusion Implementation of antimicrobial stewardship program along with hospital infection control practices is needed for preventing BSIs due to MDR organisms.

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“…These pathogens are usually endogenous. Broad spectrum antibiotics given as treatment or prophylaxis exert selection pressure leading to the survival of resistant strains of bacteria, particularly in the gut [17]. Nouer et al described how patients with haematological malignancies undergo repeated cycles of chemotherapy and receive broad spectrum antibiotics with each cycle, which provides a suitable environment for selection pressure [17].…”

Section: Discussionmentioning

confidence: 99%

Bacterial profile and antibiogram of blood stream infections in febrile neutropenic patients with haematological malignancies

Kokkayil

Agarwal

Mohapatra

et al. 2018

J Infect Dev Ctries

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Introduction: Studies have shown a shift in the prevalence from Gram-positive to Gram-negative bacteraemia in patients with haematological malignancies who develop febrile neutropenia. There are also reports on the spread of drug resistant bacteria among these patients. Information about locally prevalent bacteria and their resistance is important to guide empirical therapy. The aim of this study was to characterise the bacterial spectrum and antibiotic resistance pattern of bacteraemia in neutropenic patients with haematological malignancies Methodology: In this retrospective study, patients admitted to Haematology and Oncology units over a period of 6 months with laboratoryconfirmed positive blood cultures were enrolled. Information regarding demographic profile, clinical features, and microbiological profile were recorded. Standard procedures were applied to identify the isolates and their resistance patterns. The data collected was analysed statistically. Results:56 isolates from 53 patients were isolated of which majority were gram negative bacilli (GNB; n = 52 or 93%). Klebsiella pneumoniae (43%, n = 24) was the most frequently isolated bacteria followed by Enterobacter sp (20%, n = 11) and Escherichia coli (12%, n = 7). All isolates were susceptible to colistin. Susceptibility to cefaperazone-sulbactam, piperacillin-tazobactam and carbapenems were 32%, 28.6% and 26.8% respectively. The outcome was fatal for 25 patients. Conclusions: The study documented an alarming rise in the prevalence of GNB and their resistance. Though the results of the study may represent only the tip of the iceberg, the results demonstrate the need for treatment options for drug resistant isolates and for surveillance cultures.

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Tackling antibiotic resistance in febrile neutropenia: current challenges with and recommendations for managing infections with resistant Gram-negative organisms

Cited by 18 publications

References 82 publications

Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda

Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda

Microbiological Profile of Blood Stream Infections in Febrile Neutropenic Patients at a Tertiary Care Teaching Hospital in Rishikesh, Uttarakhand

Bacterial profile and antibiogram of blood stream infections in febrile neutropenic patients with haematological malignancies

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