Prevalence of Antimicrobial Resistant Bacterial Infections among Neutropenic Patients in Hiwa Cancer Hospital, Sulaimani, Iraq

Abstract

Background: Febrile neutropenia (FN) is one of the most serious complications of cancer chemotherapies. To avoid life-threatening complications from treatment delays, appropriate empirical antibiotic treatment should be initiated. Objective: To highlight the common bacteria encountered at Hiwa Hospital, the current state of the hospital's antibiogram and recommendations for resistance management. Method: From January 2021 to December 2022, we retrospectively collected culture-confirmed FN cases from the Hiwa Hospital system database in Sulaimani, Iraq. Results: We collected 144 culture-confirmed cases, with ninety-four from hematology wards and fifty from oncology wards. The participants’ ages ranged from 2–79 years. Seventy-three of them were male, with a male-to-female ratio of 1:0.9. Gram-negative bacteria comprised 50.7% of the total cases, 47.9% had gram-positive bacteria, and only 1.4% had fungal growth. The most common isolated pathogens were Staphylococci species (38.9%), E. coli (29.2%), Klebsiella pneumoniae (9%), Streptococcus spp. (8.3%), and Pseudomonas spp. (8.3%). A large number of Staphylococcus spp. were resistant to amoxicillin/clavulanic acid, ceftriaxone, cefepime, and levofloxacin. In contrast, E. coli was resistant to ceftriaxone, ceftazidime, cefepime, ciprofloxacin, meropenem, and piperacillin/tazobactam. Klebsiella spp. exhibited significantly higher levels of resistance to amikacin, cefepime, and ciprofloxacin. MRS strains were found in 48.2% of Staphylococci spp., 74% of gram-negative bacteria, and 12.3% of extensive drug-resistant (XDR) isolates. Conclusions: There is a high prevalence of antibacterial resistance among cancer patients, which contributes to quinolone-induced collateral damage.