Microbiological Profile and Antibiotic Resistance of Bloodstream Infections among Cancer Patients at a Tertiary Care Cancer Centre in North Kerala, India

Abstract

Introduction: Bacterial infections, especially Bloodstream Infections (BSI) are among the most frequent complications in immunosuppressed patients with cancer, and are associated with considerable morbidity and mortality and high economic costs. Patients with chemotherapy induced neutropenia, especially haematological patients with malignancies in whom the neutropenia is often profound and prolonged, and those undergoing Haematopoietic Stem Cell Transplantation (HSCT) are at higher risk for BSI. Aim: To analyse the microbiological profile of Bloodstream Infections and their antibiotic resistance pattern among the clinically diagnosed cases of sepsis in cancer patients. Materials and Methods: This retrospective study was conducted at a Microbiology Division, Department of Clinical Laboratory Services and Translational Research, Malabar Cancer Centre, Kannur, Kerala, India during the period from July 2020 to December 2020. Data of January 2016 to December 2017 on all microbial cultures from blood samples were analysed. All blood cultures during the study period were processed by Bactec 9050 Blood Culture System (Becton Dickinson Microbiology Systems, Sparks, MD, USA. After performing culture, bacterial identification and susceptibility was done by using automated culture system (VITEK 2 Compact system). Simple descriptive analysis of data was done and results presented in frequencies and percentages. Results: Total 385 (9.2%) were identified to be culture positive from 4154 blood cultures screened. Out of 385 positive cultures, 354 (92%) showed bacterial growth, gram negative were 245 (64%) and gram positive were 109 (28.3%) and fungal species were 31 (8%). Among the Gram negative bacteria (GNB), Klebsiella pneumoniae was found to be the most frequent species (n=83), followed by Escherichia coli (n=75). In gram positive bacteria, Coagulase-negative Staphylococci (CoNS) were the most common species (n=48). High prevalence of antimicrobial resistance was observed among E.coli, K.pneumoniae, Acinetobacter baumannii. Among the 48 isolates of CoNS and 26 isolates of S.aureus in which 30 (62.5%) isolates and 14 (54%) isolates respectively were found to be methicillin resistant. Conclusion: A proper antimicrobial stewardship should be followed in all healthcare centres especially cancer treating hospitals as the patients are immunocompromised. This current study on regular reporting of antibiogram with clinical guidelines will help in judicious use of antibiotics, as drug resistance is on the rise globally