#58 Establishment of an antibiogram in paediatric Oncology unit in National Cancer Institute - Sri Lanka Samanmalee Gunasekara 1, Upeka Rathnayaka 1, Deepika Vidanage 1 1 Department of Microbiology, National Cancer Institute, Sri Lanka

Abstract

Abstract Background Bacterial infection is a dreaded complication in cancer patients worldwide. In low resources setting where supportive care facilities are less than ideal this takes on even more greater significance. In recent years, the emergence of antimicrobial resistance has become a significant problem worldwide and cancer patients are among those most affected. Treatment of infections due to MDR (Multi Drug Resistant) bacteria represents a clinical challenge since the therapeutic options are limited. It is important to monitor emerging trends of antibiotic resistance in an institution to support clinical decision making and infection control interventions. Method Microbiology Laboratory received 4302 aerobic blood cultures from paediatric Oncology unit between 1st January and 31st December 2020. Aerobic bacterial blood cultures were performed in BD BACTEC automated blood culture system. All positive blood cultures were sub cultured onto blood agar and MacConkey agar. Bacterial isolates were identified and antibiotic susceptibility was tested using VITEK 2 automated system. Patient’s data, bacterial identification and sensitivity results were entered and analyzed using WHONET software. An antibiogram was developed for Gram- negative and Gram- positive organisms using analysed data. Results Seventy two blood cultures grew Gram- negative organisms including Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Burkholderia cepacia. Klebsiella pneumoniae was the predominant isolate, 47 %( n= 34) and only 21.2% of them were sensitive to meropenem. Twenty three blood cultures grew Gram- positive organisms including, Staphylococcus aureus, Coagulase negative staphylococci, and Streptococcus pneumonia. Staphylococcus aureus was the predominant isolate, 78 %( n=18) and 55% of them were MRSA (Methicillin Resistant Staphylococcus aureus). Conclusion Use of antibiogram could help in the selection of empirical choice of treatment in patients with sepsis due to neutropenia. Also the antibiogram shows high degree of antibiotic resistance among both Gram- negative and Gram- positive organisms. Therefore implementation of antibiotic stewardship program and infection control measures is the cornerstone for controlling the development and spread of these MDR pathogens in the paediatric unit. Limitations: This antibiogram was developed using only the bacterial isolates grew in the blood cultures due to financial constraints (high cost of the VITEK identification and sensitivity cards).