Febrile Neutropenic Patients Research Articles

Microbiological profile and antimicrobial susceptibility patterns of blood stream infections in febrile neutropenic patients with hematological malignancies in a tertiary care hospital, Kolkata

Microbiological profile and antimicrobial susceptibility patterns of blood stream infections in febrile neutropenic patients with hematological malignancies in a tertiary care hospital, Kolkata

Non-cancer febrile neutropenia in children: pathogens, antimicrobial susceptibilities, and outcomes

BackgroundFebrile neutropenia is a medical emergency and remains a significant cause of morbidity and mortality, it is defined as a temperature > 38.3 °C (101 °F), or a sustained temperature > 38.0 °C (100.4 °F) for more than 1 h in a neutropenic patient. Neutropenia is defined as a decrease in the absolute number of neutrophils in the blood < 1500 cells/ mm3 in children.Aim of the studyTo identify the specific pathogens causing infections, determine antimicrobial susceptibility, and identify factors associated with morbidity and mortality in febrile neutropenic children.MethodsA prospective cohort study, 38 non-cancerous pediatric patients admitted with 61 febrile episodes, was conducted. Sepsis screen, pan-cultures, and tests to identify the causative pathogens and antimicrobial sensitivity were collected.ResultsCoagulase-negative staphylococci (CONS) infection accounted for 38.4% of all positive cultures, while Klebsiella infection represented 23%. SARS-CoV2 (severe acute respiratory syndrome coronavirus 2) virus infection accounted for 23% of febrile episodes that lead to COVID-19 (coronavirus disease of 2019) sickness; however, it did not significantly impact patients’ outcomes. Unfavorable outcomes were associated with higher C-reactive protein (CRP) levels, positive blood cultures, and gram-negative organisms (p = < 0.001, 0.013, 0.038 respectively). Prolonged duration of fever and elevated CRP levels were significant predictors of poor outcomes in febrile neutropenia, with a sensitivity of 88.9% and 100% and specificity of 70.6% and 62.3%, respectively.ConclusionAmong febrile neutropenic patients, CONS is the most common pathogen, while Klebsiella is the most common gram-negative infection. Gram-positive organisms predominate in bloodstream infections. Prolonged duration of fever and elevated CRP levels can significantly predict poor outcomes.

Early Therapeutic Drug Monitoring Optimizes Teicoplanin Use in Febrile Neutropenic Patients with Hematological Malignancies.

A target trough concentration (Cmin) of teicoplanin ≥ 15-20mg/L between the fourth and sixth day has been suggested for severe infections or management of febrile neutropenia (FN). Owing to no reports discussing the impact of early target attainment on treatment outcomes, this study aimed to evaluate the dose-Cmin relationship and clinical outcome and estimate the optimal early target Cmin for FN in patients with hematological malignancies. This single-center, prospective study enrolled patients with hematological malignancies who were treated with teicoplanin either as an empirical antibiotic for FN or as targeted treatment for Gram-positive bacteria. Blood samples were collected on day three (48h) post-loading doses, day5 (96h), and day8 (when applicable) and determined by ultrahigh-pressure liquid chromatography-triple quadruple mass spectrometry. A total of 117 samples from 47 patients with FN (27 men, 20 women) were consecutively analyzed. A two-tailed αvalue of 0.05 was considered statistically significant. The mean Cmin values at 48h, 96h, and on day8 were 23.4, 21.4, and 27.8mg/L, respectively. The patients achieving Cmin ≥ 20mg/L at 48h had a higher likelihood of treatment success. The areas under the receiver operating characteristic curves were 0.71 for clinical efficacy and the cutoff value of Cmin at 48h was 18.85mg/L (95% confidence interval 0.55-0.87; P = 0.018). The Cmin of teicoplanin after completion of loading doses could predict the treatment response, with a target concentration ≥ 18.85mg/L.

Outcome of Tocilizumab Treatment in Febrile Neutropenic Children with Severe Sepsis/Septic Shock in a Single-Center Retrospective Case Series.

To assess the efficacy of an IL-6 blockade with tocilizumab on treatment outcome of severe sepsis/septic shock in children with febrile neutropenia. We performed a retrospective study of febrile neutropenic patients younger than 18 years old who developed severe sepsis/septic shock at a single medical center between November 2022 and October 2023. Seven patients with febrile neutropenia complicated with severe sepsis/septic shock were identified. Four of seven patients received tocilizumab in addition to standard of care. The median IL-6 level before administration of tocilizumab was 14,147 pg/mL (range: 672-30,509 pg/mL). All four patients successfully recovered from severe sepsis/septic shock. Three of seven patients received standard of care without tocilizumab. IL-6 levels were checked intwo2 patients, with a median of 1514.5 (range: 838-2191). Only one of three (33%) patients without tocilizumab therapy made a full recovery from severe sepsis/septic shock. The mortality rate was higher in patients without tocilizumab therapy compared to patients with tocilizumab therapy (67% vs. 0%). Administration of tocilizumab reduced mortality of severe sepsis/septic shock in children with febrile neutropenia. However, it warrants confirmation with a larger number of patients and a longer follow-up.

Systematic review on efficacy and safety of empirical versus pre-emptive antifungal therapy among children with febrile neutropenia reveals paucity of data.

Two approaches are used to manage invasive fungal disease (IFD) in febrile neutropenic patients viz. empirical therapy (without attempting to confirm the diagnosis), or pre-emptive therapy (after screening tests for IFD). This systematic review was undertaken to compare these approaches in children. We searched PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, CINAHL, Clinical Trial Registries and grey literature, for randomized controlled trials (RCT) comparing empirical versus pre-emptive antifungal therapy in children with FN suspected to have IFD. We used the Cochrane Risk of bias 2 tool for quality assessment, and evaluated the certainty of evidence using the GRADE approach. We identified 7989 citations. Stepwise screening identified only one relevant RCT that administered empirical (n = 73) or pre-emptive (n = 76) antifungal therapy. There were no significant differences in all-cause mortality (RR 1.56, 95% CI: 0.46, 5.31), IFD mortality (RR 1.04, 95% CI:0.15, 7.20) and other clinically important outcomes such as duration of fever, duration of hospitalization and proportion requiring ICU admission. There were no safety data reported. The number of days of antifungal therapy was significantly lower in the pre-emptive therapy arm. The certainty of evidence for all outcomes was 'moderate'. This systematic review highlighted the paucity of data, comparing empirical versus pre-emptive antifungal therapy in children with febrile neutropenia having suspected invasive fungal disease. Data from a single included trial suggests that both approaches may be comparable in research settings. Robust trials are warranted to address the gap in existing knowledge about the optimal approach in clinical practice.

Epidemiology of Febrile Neutropenic and Bacteremic Patients in the Extensively Drug-Resistant Era

Background: Appropriate empiric antibiotic use is of utmost importance in febrile neutropenic patients. This study analyzed positive blood culture reports from febrile neutropenic patients and provided a new empirical antibiotic treatment approach. Methods: This study retrospectively enrolled febrile neutropenic patients with hematological or solid organ malignancies who had positive blood cultures at the Bahrain Oncology Center within January 2019 to August 2021. Microbiological data were used to draw inferences for rational antimicrobial treatment. The quick sequential organ failure assessment (qSOFA) score was employed to classify the severity status. The t-test was used to compare univariate and multivariate sensitivity values for two dependent proportions. Results: A total of 73 episodes of bacteremia were detected in 53 patients. Among these, 54 episodes (74%) were caused by gram-negative organisms. The most commonly isolated organisms were Escherichia coli (30%), Klebsiella pneumonia (22%), and coagulase-negative staphylococci (11%). The rate of extensively drug-resistant strains among K. pneumoniae was 44% (n = 7). Among gram-negative microorganisms, the susceptibility rates for monotherapies were reported for ceftazidime (56%), piperacillin/tazobactam (76%), cefepime (54%), meropenem (80%), and ceftazidime-avibactam (91%). The susceptibility rates for tigecycline-based combinations exceeded 90% overall. Conclusions: Clinical severity and local epidemiological data should be considered in the management of febrile neutropenia. New antibiotics and tigecycline should be considered for combination therapy in selected cases due to the increasing resistance observed.

Granulocyte Transfusions in Neutropenic Infections: Insights From a Single-Center Study.

Introduction Despite the development of modern antibiotic and antifungal therapies, neutropenic infections remain life-threatening. Granulocyte transfusion (GTX) is a less frequently used treatment modality in patients with refractory neutropenic infections. The role of donor GTX remains controversial, partly because of the lack of proper clinical trials. This study aimed to contribute to the literature by evaluating the efficacy and side effects of granulocyte transfusions in our center. Methods Eight febrile neutropenic patients with confirmed infections received granulocyte transfusions from ABO-compatible related and unrelated donors. Donors received filgrastim and dexamethasone stimulation, and granulocyte suspensions were irradiated and administered within six hours. Monitoring, antibiotic therapy, and granulocyte colony-stimulating factor (G-CSF) support were maintained. Results Our study observed a 28-day survival rate of 25%, which was lower than that reported in previous literature. The median number of transfusions was 3, with an average eight-day duration post-infection diagnosis, and no side effects were observed. Conclusion While some patients benefited from GTX, overall survival rates remained modest, indicating the need for further research. Prospective, well-powered randomized controlled trials are essential to address patient selection, dosing, and duration to determine the clinical utility of GTX. This study underscores the complexity of GTX in real-world clinical practice and provides insight into the ongoing debate regarding its efficacy in treating severe neutropenic infections.

Risk factors for resistant gram-positive bacteremia in febrile neutropenic patients with cancer

BackgroundGram-positive bacteria are frequently resistant to empirical beta‐lactams in febrile neutropenic patients with cancer. As microbiology and antibiotic susceptibility changes, we reevaluated the risk factors for resistant Gram-positive bacteremia in febrile neutropenic patients with cancer. MethodsEpisodes of bacteremic febrile neutropenia in Seoul National University Hospital from July 2019 to June 2022 were reviewed. Resistant Gram-positive bacteria were defined as a pathogen susceptible only to glycopeptide or linezolid in vitro (e.g., methicillin-resistant staphylococci, penicillin-resistant viridans streptococci, and ampicillin-resistant enterococci). Episodes were compared to identify independent risk factors for resistant Gram-positive bacteremia. ResultsOf 225 episodes, 78 (34.7%) involved resistant Gram-positive bacteremia. Multivariate analysis revealed that breakthrough bacteremia while being administered antibiotics (adjusted odds ratio [aOR], 6.794; 95% confidence interval [95% CI], 3.130–14.749; P < 0.001) and catheter-related infection (aOR 4.039, 95% CI 1.366–11.946; P = 0.012) were associated with resistant Gram-positive bacteremia. Chronic liver disease (aOR 0.231, 95% CI 0.059–0.905; P = 0.035) and hypotension at bacteremia (aOR 0.454, 95% CI 0.218–0.945; P = 0.035) were inversely associated with resistant Gram-positive bacteremia. ConclusionsResistant Gram-positive bacteria should be considered in breakthrough bacteremia and catheter-related infection in febrile neutropenic patients with cancer.

A Systematic Review of Three Biomarkers to Aid in the Assessment of Outcomes for Children and Young People with Cancer that are Febrile Neutropenic

For paediatric patients with cancer, febrile neutropenia (FN) is the most common complication of treatment. It requires inpatient hospitalisation and treatment with empirical broad-spectrum antibiotics. Approximately 20-30% of febrile neutropenic patients have a documented infection, thus needing antibiotics. For the rest, it is suggested that the cause of FN could be a viral or fungal infection, the malignancy itself, drug related or the result of a blood transfusion reaction as examples, therefore not requiring antibiotics. With no risk-stratification tool in use in practice to distinguish between patients who are at high or low risk of bacterial infections, recent studies have focused on identifying clinical and laboratory markers for this. This systematic review will focus on three biomarkers, C-reactive protein (CRP), presepsin (sCD14-ST) and lactate, to find their sensitivities and specificities for diagnosing bacterial infections and thus help determine the risk of poor outcomes for patients with FN. This review has systematically searched for relevant primary research papers. These studies have been critically appraised using a validated critical appraisal tool. Data from these studies were then extracted using a data extraction form, and evidence summarised. The findings have been interpreted, and the implications to practice and research are discussed. 1051 febrile neutropenic episodes from 743 children from different countries were analysed. In the majority of studies (75%), acute lymphoblastic leukaemia was the most frequent diagnosis. Eight of the studies in this review are looking at CRP. Two studies are looking at lactate, and five review presepsin. Lactate is a sensitive and specific biomarker with a lactate level ≥ 2mmol/L and &gt;2.5mmol/L showed sensitivities of 81% and 80% and specificities of 83% and 92.1%, respectively. Presepsin and CRP had mixed results for its sensitivity and specificity. Lactate and CRP are useful biomarkers for assessing the outcomes of children with FN and could be added to a CDR. This review cannot confirm that presepsin is a useful biomarker for practice and, therefore, cannot justify adding it to a CDR.

Comparison between amphotericin b and posaconazole as consolidation therapy in invasive fungal sinusitis (mucormycosis)

Aim: To analyse the effects of combination therapy with Injection liposomal Amphotericin B (LAmB) and Tablet Posaconazole in Mucormycosis. Acute invasive fungal sinusitis is an uncommon disease that often has rapid and destructive clinical progression. Priorly, a disease of the immuno-compromised, Invasive fungal sinusitis is typically associated with patients undergoing chemotherapy, stem cell transplantation as well as in patients with uncontrolled diabetes mellitus and patients using corticosteroids. Materials and methods: This retrospective observational study was carried after obtaining institutional ethical committee on a total of 40 patients with history of diabetes mellitus, covid positivity, infusion of steroid injections and immuno-compromised were admitted and treated between May 2021 to July 2021. Results: Any potential combination therapy study under consideration for testing in patients with Mucormycosis should use polyene, as backbone therapy. Injection Amphotericin B remains the only antifungal agent licensed by the US Food and Drug Administration for primary therapy of Mucormycosis. Tablet Posaconazole reported 90% minimum inhibitory concentrations with Mucorales range from 1 to &gt;=4 microgram/ml. In febrile neutropenic patients or those with mucormycosis, Conclusion: Mucormycosis is a disease of increasing frequency. It continues to have a higher mortality rate than most other infections, frequently affects young patients.

Pattern of bacterial infections in neutropenic febrile patients (experience of the Specialized BMT center - Medical city complex - Baghdad, Iraq)

Abstract: BACKGROUND: Infectious complications occur in most of the patients undergoing hemopietic stem cell transplantation (HSCT), these carry high risk of mortality mainly due to Gram-negative bacteria unless effective antibiotic treatment is provided. OBJECTIVES: The aims of the study were to review bacterial isolates from different samples in febrile neutropenic patients underwent HSCT in terms of incidence, types, and antimicrobial resistance, and to assess the efficacy of infection control measures used in transplantation ward. PATIENTS AND METHODS: This is retrospective study. The medical records of a total of 82 patients who underwent HSCT in the Specialized BMT Center, Baghdad Medical City, in 2021 and 2022 were reviewed; for any patient with neutropenic fever (NF), the clinical assessment was made, and samples were taken for culture any sensitivity before starting empirical antibiotics. The study was reviewed by the ethical committee of the hematology transplant center in the Medical City Complex, and since the study is retrospective, no consent is needed from the patient. RESULTS: There were 57 patients who developed NF, two at the time of collection, while 55 patients during transplant. In 16 patients, there was a clinical focus for NF, most commonly respiratory. From 175 samples sent for culture and sensitivity, bacterial growth was detected in 103 samples, and the incidence of bloodstream infection was 53%. Polymicrbial bacterial growth was detected in 6 patients with NF. Gram-positive bacteria were slightly more common than Gram negative. Staphylococcus epidermidis and Burkholderia cepacia were the most common Gram positive and Gram negative, respectively. An increasing number of patients admitted to transplant centers were associated with more infections. Ten out of 13 bacteria were multidrug resistant (MDR). Only two patients died from infection posttransplant. CONCLUSIONS: The predominance of Gram-positive cocci and Burkholderia cepacia complex supported the need to review the adherence to infection control policy. The empirical antibiotic protocol should be guided by local antibiogram, and since the high rate of blood stream infection (BSI) with MDR pathogens, a de-escalating strategy utilizing carbapenems – as advised by the ECIL-4 guidelines – would be more appropriate while awaiting culture result. The ability to quickly identify infections and their susceptibility profile is still crucial for choosing antibiotic therapy.

2805. Extended-Infusion versus Intermittent-Infusion Piperacillin/tazobactam for High Minimum Inhibitory Concentration Pseudomonas aeruginosa Infections

Abstract Background Extended-infusion (EI) piperacillin/tazobactam, compared to intermittent-infusion (II) piperacillin/tazobactam, has been associated with improved clinical outcomes for both critically ill and febrile neutropenic patients. However, there is a paucity of data on whether these clinical benefits apply to broader populations. Infections involving high minimum inhibitory concentration (MIC) Pseudomonas aeruginosa represent an additional group where optimization of pharmacokinetic parameters may impact treatment success. Methods Medical records of adults who received II or EI piperacillin/tazobactam for pneumonia and/or bacteremia caused by Pseudomonas aeruginosa with MIC 8 or 16 mcg/mL were reviewed. The primary outcome was 30-day all-cause mortality. Hospital and/or intensive care unit (ICU) length of stay (LOS) and recurrence of infection were also recorded. Additionally, an escalation of care composite was assessed by need for new ICU transfer, new vasopressor start, new mechanical ventilation, or rescue antibiotic therapy change. Finally, a safety outcome of acute kidney injury (AKI) was recorded. Results A total of 69 patients were included, 31 in the II group and 38 in the EI group. Bacteremia was detected in 19.4% and 23.7% of the II and EI groups, respectively (p = 0.66). Baseline demographics and characteristics of treatment were similar between groups. The most common dosing regimens were 3.375 g IV every 6 hours over 30 minutes and 3.375 g IV every 8 hours over 4 hours. 30-day mortality was 32.3% in the II group and 39.5% in the EI group (p = 0.54). Similarly, hospital LOS (19 versus 15 days, p = 0.27) and ICU LOS (23 versus 15 days, p = 0.15), as well as recurrence (29.4% versus 23.5%, p = 1) and therapy escalation (38.7% versus 47.4%, p = 0.47), were not significantly different between groups. 43.5% of patients in the II group and 40.6% of patients in the EI group developed AKI (p = 0.83). Conclusion The present study found no significant difference in outcomes between piperacillin/tazobactam infusion strategies. However, the small sample size and complex patient factors may have limited the comparison. Disclosures Dustin R. Carr, PharmD, BCPS, BCIDP, Merck: Advisor/Consultant Thomas L. Walsh, MD, Accelerate Diagnostics: Advisor/Consultant Derek N. Bremmer, PharmD, BCIDP, Thermo Fisher Scientific: Advisor/Consultant

1709. Shifting Infection Spectrum in Febrile Neutropenic Pediatric Cancer Patients During the COVID-19 Pandemic: An Impact Assessment

Abstract Background Febrile neutropenia (FN), which is the most common reason for hospital admission among pediatric oncology patients recieving chemotherapy, has seen changes in the epidemiology of infectious pathogens over the past few decades. This is attributable to shifts in hospital flora, antibiotics usage, and resistance patterns. Previously, bacterial infections were more common in this population, with mycobacterial, viral, and protozoal organisms being less frequent. Gram-negative bacteria such as E. coli, Klebsiella, and Pseudomonas were the most common causative agents. However, with the onset of the COVID-19 pandemic, the implementation of nationwide lockdowns, reduced healthcare visits, and strict interpersonal preventive measures are anticipated to impact the previous trends. Methods A 16-month prospective observational study was conducted on 131 eligible pediatric cancer patients (ages 1-12) admitted with febrile neutropenia from Dec 2019 to May 2021. Causative pathogens were identified through lab investigations upon admission, and on days 3 and 7. Results Out of the 131 children enrolled in the study, an etiological agent could be identified in 72. SARS-CoV-2, Acinetobacter, and Klebsiella accounted for over 50% of the infections. SARS-CoV-2 was the most common pathogen, and non-SARS-CoV-2 coronaviruses were also detected, even more than E. coli.Overall, gram-negative infectious agents comprised the most common pathogens (35.2%), similar to the pre-COVID era, followed by an appreciably increased respiratory viral burden (32.3%), a markedly decreased proportion of gram-positive infections (11.2%), and lastly, a largely unchanged fungal contribution (11.2%). Major etiological agents in febrile neutropenia patients Conclusion Rigorous interpersonal precautions and hygiene practices that were reinforced during the pandemic are effective in preventing hospital-acquired and contact-transmitted infections caused by gram-positive bacteria. However, despite the strict preventive measures and travel restrictions, transmission of airborne infections between immunocompromised patients and their caregivers was not avoided and became the most prevalent infection in the group. The risk of infection from the overgrowth of endogenous gram-negative flora remains unchanged. Disclosures All Authors: No reported disclosures

Clinical and Microbiological Profile and Factors Affecting Outcome among Pediatric Febrile Neutropenic Patients with Hematologic Malignancies.

Clinical and Microbiological Profile and Factors Affecting Outcome among Pediatric Febrile Neutropenic Patients with Hematologic Malignancies.

Validation of Risk Scale in Febrile Neutropenic Patients with Cancer in Guatemala

Abstract Background In National Unit of Pediatric Oncology (UNOP) located in Guatemala City an average of 150 patients are treated per day in outpatient and emergency consultation. The episodes of neutropenia post chemotherapy were recognized as predisposing factors for infections. Methods Prospective analytical observational study of pediatric cancer patients with episodes of febrile neutropenia, attended at the National Pediatric Oncology Unit (UNOP) in Guatemala. The following inclusion criteria apply: Patients age under 18 years old and diagnosis of cancer and febrile neutropenia defined by temperature above 38.3 C, ANC ≤ 500 secondary to chemotherapy in the past 7 days. Exclusion criteria apply patients with fever and neutropenia but not received chemotherapy and patients with an infectious focus. The primary endpoint was evaluated the performance of the risk categorization scale in febrile neutropenic patients. Secondary end points were admission to paediatric intensive care unit, death, reactive protein C value (CRP) and bacterial infection. Results A total of 28 episodes of fever and neutropenia recruited between November 2021 and July 2022 were classified 14 (50%) in low risk and 14 (50%) in high risk. Blood cultures were positive in 5 patients (17.9%). The risk scale was not statistically significative to predict bacteremia because two low risk patients have positive blood cultures, X2 was 0.243 (p=0.622) RR 0.917 95% CI (0.648 – 1.30). The majority of pathogens (4/5) were Gram- negative. Admission at intensive care unit in patients with high risk was statistically not significant x2 1.17 (p = 0.280). The calculated relative risk is 3.01 95% CI (0.621-1.15) without any deaths. According to the risk classification CRP ≥ 90 mg/L at 72 hours was 21.4% and 64.3% in patients with low and high risk respectively, X2 5.25 (p = 0.022). Conclusion The scale performance in the study was not statistically significative to predict bacteriemia in patients with febrile neutropenia, however it was clinically relevant to predict admission at unit intensive care for high risk patients. The early detection of a bacteremia and the rapid therapeutic intervention are crucial to improve the outcome

The Role of Inflammatory Indices in Predicting Infections and Guiding Treatment in Neutropenic Patients With Solid Tumors

Introduction: This study explores the link between inflammatory markers and hospital outcomes in febrile neutropenic patients with solid cancers- a complication caused by systemic chemotherapy that can lead to hospitalization and requires timely diagnosis and treatment to reduce fatalities. Methods: This study was conducted in 2017 at Vali-e-Asr Hospital in Birjand with 22 participants. Blood samples were collected to measure inflammatory indexes. The study documented various hospital outcomes, including duration of neutropenia and fever correction, length of hospital stays, ICU admission or mechanical ventilation, and mortality. Accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each marker. Results: According to the findings, there was no significant difference in the mean duration of neutropenia, the duration of fever, or the length of hospital stay comparing procalcitonin (PCT; P=0.96, P=0.36, P=0.66, respectively), polymorphonuclears (PMNs; P=0.11, P=0.94, P=0.52, respectively), and erythrocyte sedimentation rate (ESR; P=0.41, P=0.24, P=0.17, respectively). Further, the performance metrics calculated for PCT, ESR, and PMNs were an accuracy of 50%, 50%, and 40.90%, sensitivity of 88.8%, 100%, and 88.8%, specificity of 23.07%, 15.38%, and 7.6%, PPV of 44.4%, 45%, and 40%, and NPV of 75%, 100%, and 50%, respectively. Conclusion: Our findings suggested that there was no significant relationship between inflammatory factors and hospital outcomes. However, further research is needed to explore the prognostic value of these markers in a larger and more diverse patient population.

Bloodstream Infections in Paediatric Cancer Patients with Febrile Neutropenia in a Tertiary Cancer Centre in North-East India

Background: The aim of the present study was to study the pattern of microbial flora, their susceptibility patterns, and clinical variables among bloodstream infections in febrile neutropenic patients with solid tumors and hematological malignancies in the paediatric age group in North-East India. Methods: It was a retrospective and observational study done in a single tertiary care cancer centre in North-East India. The study period was from 1st January 2020 to 31st December 2021. The study population included all the patients below the age of 18 years who developed febrile neutropenia during treatment for a diagnosed cancer. Results: A total of 378 blood culture samples were studied. Febrile neutropenia was found in 252 patients (66.7%). There were 45 positive blood cultures (17.8%) among them. Gram-negative and gram-positive organisms accounted for 62% and 38% of all positive cultures respectively. Escherichia coli (39%) was the most common gram-negative isolate, followed by Klebsiella pneumoniae (32%), Pseudomonas aeruginosa (18%) and Acinetobacter baumannii (7%). Coagulase-negative Staphylococci (CoNS) was the most common gram-positive isolate (47%). Sensitivity to beta-lactam/beta-lactamase inhibitor (BL/BLI) antibiotics like cefaperazone/sulbactam was seen in 60% of Pseudomonas isolates. Sensitivity to colistin was noted in 89% of Klebsiella and 82% of E. coli isolates. The incidence of methicillin resistant staphylococcus aureus (MRSA) was 50%. Conclusion: The knowledge of the microbiological profile and resistance patterns among patients treated for paediatric cancer with febrile neutropenia is a key factor in deciding the antimicrobial policy.

Prevalence of blood stream infections and associated factors among febrile neutropenic cancer patients on chemotherapy at Ocean Road Cancer Institute, Tanzania

BackgroundFebrile Neutropenia (FN) caused by bacteria in cancer patients is associated with poor prognosis. The aim of this study was to determine the prevalence of FN and associated factors among cancer patients on chemotherapy at Ocean Road Cancer Institute (ORCI), Tanzania.MethodsA cross-sectional study was conducted from June to September 2019. Study participants were conveniently recruited. A desk review of participants medical records was performed. Standard microbiological procedures used to culture and identify the bacterial isolates from the positive blood cultures of participants that presented with FN. Kirby-Bauer disc diffusion was used to perform the antibiotics susceptibility testing. SPSS version 20.0 and MS Excel were used in data entry and analysis. Chi-Square was used as a measure of association between various factors and neutropenia. P-value less than 0.05 was considered statistically significant.ResultsA total 213 participants were enrolled. Of these 76.1% were female. Most of the participants came from the Coast region. Majority of participants presented with breast Cancer (36.2%) and GIT (20.2%). The prevalence of FN and bacteremia was 5.6% and 35.3% respectively. Staphylococcus Aureus (60%) and Coagulase-Negative Staphylococci (40%) were the main isolates. Of the 6 isolates tested most were resistant to Co-Trimoxazole 4/6 (66.7%) and Doxycycline 3/6 (50%). FN was positively associated with chemotherapy regimen (P = 0.0001), platelets count (P = 0.0001) and use of G-CSF (P = 0.0001).ConclusionThe prevalence of FN among the cancer patients on chemotherapy in Tanzania is low but associated with drug-resistant bacteria.

PCR-based rapid identification of methicillin-resistant Staphylococcus aureus strains and their antibiotic resistance profiles in febrile neutropenic patients

PCR-based rapid identification of methicillin-resistant Staphylococcus aureus strains and their antibiotic resistance profiles in febrile neutropenic patients

Role of rapid tests in diagnosis of bloodstream infections and their effect on promoting antibiotic stewardship among febrile neutropenic patients in Alexandria

Abstract Background Bloodstream infections (BSIs) in neutropenic patients significantly contribute to morbidity and mortality. The rapid identification and determination of antimicrobial susceptibility of pathogens causing BSIs can help in early initiation of targeted antimicrobial therapy and allow de-escalation of unnecessary empirical antimicrobials. Aim This study evaluated the rapidity and accuracy of gram-stained smear from blood culture bottles and direct VITEK 2 to identify and determine antimicrobial susceptibility of pathogens causing BSIs and assessed the effect of these tests on modification of empiric therapy. Patients and methods Blood cultures were collected from 100 febrile neutropenic patients from the Hematology Unit in Alexandria Main University Hospital. Gram-stained smears were prepared from blood culture bottles; blood from bottles with suggestive smears was directly inoculated into the VITEK 2 system, and results were compared with conventional methods. Results were instantly reported to clinicians. Empirical antimicrobials and their modification were recorded. Results BSI was detected in 30% of patients. Gram-negative bacteremia was predominant (24/30). Gram-stained smears showed complete accordance with conventional methods in 99 samples. VITEK 2 correctly identified all tested microorganisms, and the overall agreement in susceptibility testing was 100 and 95.2% for gram-positive and gram-negative bacteria, respectively. The effect of these rapid tests on empiric antimicrobial therapy was evident in 12 of 30 patients with documented BSIs (40%). Conclusion Gram-stained smear and direct VITEK 2 testing when integrated with instant reporting is a valid approach to guide targeted therapy in neutropenic patients in the context of extremely resistant pathogens.