Abstract
Introduction Cancer patients being immunosuppressed are vulnerable to develop infections. Knowledge of the changing epidemiology of infections has a pivotal role in its management. Aims and Objectives. The study is undertaken to assess the types of bacterial infections in cancer patients undergoing anticancer treatment, the associated bacterial pathogens, and their antibiotic sensitivity patterns. Materials and Methods A retrospective surveillance study was undertaken in our center. Positive culture reports and other clinical details of cancer patients diagnosed with infection during a stay in the tertiary care center from 1st January 2015 to 31st December 2016 were analysed by descriptive statistical methods chi-square test and odds ratio to study the association. Results Out of 638 cancer patients diagnosed with infections in the 2-year period, 140 patients had positive cultures, representing 272 specimens and 306 isolates. Common specimens sent for culture were blood sputum, urine, and pus. 214 isolates (69.9%) were gram-negative bacilli, and 92 (30.1%) were gram-positive cocci. The most common isolates were Klebsiella spp. (18.30%), Pseudomonas spp. (17.65%), and Escherichia coli (14.71%) followed by Staphylococcus aureus (13.72%). Among the gram-negative organisms, the antibiotic resistance rates reported to fluoroquinolones, aminoglycosides, and third-generation cephalosporins were 45.13%, 39.20%, and 48.58%, respectively. 26.92% of the organisms are resistant to all three antibiotics. 50.4% of Klebsiella spp. and Escherichia coli were ESBL producers. Gram-negative organisms showed 11.63% resistance to β-lactam/β-lactamase inhibitor combination, and 22.22% of gram-negative organisms are resistant to carbapenems. 50% of the Staphylococcus spp. were methicillin resistant, but all were sensitive to vancomycin. Conclusion The surge in the number of gram-negative infections emphasizes the need for broad-spectrum empirical therapy targeting the same. Rate of resistance of the isolated gram-negative organisms to the routinely used empirical therapy is alarming. Prudent use of antibiotics, based on culture reports wherever possible, is of utmost importance to save the lives of infected patients and prevent further development of antibiotic resistance.
Highlights
Cancer patients being immunosuppressed are vulnerable to develop infections
Whilst the mortality rates have fallen over the past years, infection remains a primary or associated cause of death, with bacteria most commonly accounting for infection-associated mortality, followed by fungi [2]. e management of the infections is based on the use of appropriate empirical antimicrobial therapy with a comprehensive understanding of the commonly encountered pathogens and antibiotic sensitivity patterns
Positive cultures were subcultured onto blood agar, chocolate agar, and MacConkey agar (HiMedia) and incubated aerobically at 35°C for 18 hours. e identification of the bacterial growth and antimicrobial susceptibility testing of the isolates was performed using the VITEK 2 system (BioMerieux, France), and minimum inhibitory concentration (MIC) was interpreted as sensitive or resistant using the Clinical and Laboratory Standards Institute (CLSI) guidelines. e antibiotics tested in VITEK 2 system included amikacin, amoxyclav, ampicillin, cefixime, ceftazidime, ceftriaxone, ciprofloxacin, ertapenem, imipenem, meropenem, gentamicin, piperacillin tazobactam, and trimethoprim-sulfamethoxazole for gramnegative organisms. e antibiotics for gram-positive cocci were cefoxitin, cefalothin, cefoperazone, gentamicin, erythromycin, clindamycin, chloramphenicol, rifampicin, netillin, linezolid, teicoplanin, and vancomycin
Summary
Cancer patients being immunosuppressed are vulnerable to develop infections. Knowledge of the changing epidemiology of infections has a pivotal role in its management. E study is undertaken to assess the types of bacterial infections in cancer patients undergoing anticancer treatment, the associated bacterial pathogens, and their antibiotic sensitivity patterns. Positive culture reports and other clinical details of cancer patients diagnosed with infection during a stay in the tertiary care center from 1st January 2015 to 31st December 2016 were analysed by descriptive statistical methods chi-square test and odds ratio to study the association. Rate of resistance of the isolated gram-negative organisms to the routinely used empirical therapy is alarming. E management of the infections is based on the use of appropriate empirical antimicrobial therapy with a comprehensive understanding of the commonly encountered pathogens and antibiotic sensitivity patterns. The relative incidence of International Journal of Microbiology gram-negative bacterial infections has declined over the past 20 years, but gram-positive bacteria are more commonly seen [3].
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