Infections In Oncology Patients Research Articles

QAPI 23 - Targeting Complex Colorectal Procedures to Reduce Organ Space Surgical Site Infections in Oncology Patients

QAPI 23 - Targeting Complex Colorectal Procedures to Reduce Organ Space Surgical Site Infections in Oncology Patients

Real-world Experience of Posaconazole Therapeutic Drug Monitoring in Oncology Patients: Clinical Implications of Hypoalbuminemia as a Predictor of Subtherapeutic Posaconazole Levels.

Posaconazole maintains broad antifungal activity and is employed for prevention and treatment of invasive fungal infections in oncology patients. Older formulations required therapeutic drug monitoring, and specific plasma drug levels have been recommended. This study evaluated factors associated with subtherapeutic concentrations with the newer delayed-release tablet formulation. In this retrospective, single-center cohort study at a national comprehensive cancer center, all oncology patients receiving delayed-release posaconazole at standard dosing of 300 mg orally per day from 06/2021 to 07/2023 with plasma drug concentration evaluation were identified. Demographic, clinical, and laboratory data were evaluated to identify risk factors associated with subtherapeutic drug levels at targets of ≥1.25 µg/mL and ≥1.8 µg/mL. Of 110 patients identified, 98 met criteria for inclusion in the study. The median time from initiation of posaconazole to drug level assessment was 13 days, and the median concentration was 1.29 µg/mL. Of the 22 patients receiving posaconazole for prophylaxis, 5 (22.7%) failed to achieve concentrations ≥0.7 µg/mL, and of 76 patients receiving posaconazole for treatment, 38 (50%) failed to achieve concentrations of ≥1.25 µg/mL. In multivariable analysis, albumin of ≤3 g/dL and ideal body weight ≥60 kg were found to be associated with subtherapeutic levels. For a higher target of ≥1.8 µg/mL, only albumin ≤3 g/dL was associated with subtherapeutic levels for the variables evaluated. A higher initial dosing strategy and therapeutic drug monitoring for oncology patients with albumin ≤3 g/dL receiving posaconazole, particularly for the treatment of invasive fungal infection, could be considered.

The diagnostic utility of computed tomography scans performed for febrile neutropenia in a single centre

BackgroundComputed tomography (CT) imaging has become a first line investigation for most cases of febrile neutropenia (FN) which can be the only sign of infection in oncology patients undergoing active chemotherapy and bone marrow transplants. The utility of routine non-targeted imaging remains unclear. ObjectiveTo assess and compare the diagnostic rate between targeted, non-targeted and pan-scan CT in identifying an acute source of infection in adult oncology patients with FN. Materials and MethodsA retrospective observational study was conducted between February 2019 and March 2023 on 417 consecutive CT examinations for the clinical indication of source identification in FN. Scans were noted for the anatomical regions that were imaged and reports were classified as positive, negative or equivocal for infection. Pre-existing pathology was also noted. Results were tabulated and statistical analyses for comparison between groups of scans was performed using chi-square test. ResultsAll targeted regional scans had statistically significant difference in positive rate compared to non-targeted scans of the respective region; chest (Χ²(1)=18.11, P<.001); sinus (Χ²(1)=15.36, P<.001); abdomen and pelvis (Χ²(1)=5.95, P=.01). Pneumonia (41.3 %) was much more likely to be the diagnosis compared to sinusitis (16.2 %) in concomitant CT chest to sinus examinations (Χ²(1)=45.3, P<.001). Pan-scans had a higher incidence of positive diagnosis compared to all-targeted scans (Χ²(1)=4.91, P=.03) but when compared to higher yield targeted scans (abdomen and chest), there was no statistical difference (Χ²(1)=2.43, P=.12). 20/54 patients had pan-scans despite having localising symptoms. ConclusionImaging guided by presenting signs and symptoms can help to reduce unnecessary imaging and promote more judicious use of non-targeted and pan-scan CT in current practices.

Etiological factors of bloodstream infections in oncological patients, who was hospitalized at the National Institute of Maria Skłodowska-Curie - National Research Institute in Warsaw in 2020-2022.

The purpose of the study was the microbiological analysis of bloodstream infections in patients hospitalized at the National Institute of Oncology, Maria Skłodowska-Curie - National Research Institute in the period from 01/01/2020 to 31/10/2022. In the period from 01/01/2020 to 31/10/2022, 18,420 blood cultures obtained from patients hospitalized at the NIO-PIB were analysed in the Department of Clinical Microbiology (total for the presence of bacteria and fungi). Culture for the presence of bacteria was carried out in the BactAlert automatic system by bioMerieux, and for fungi in the Bactec FX automatic system by Becton Dickinson. 1,184 strains of bacteria and 32 strains of fungi considered to be the etiological factor of the infection were cultured from clinical samples. Gram-positive bacteria accounted for 61.57%, while Gram-negative bacteria accounted for 32.26% of all isolated bacterial strains. The most frequently cultured strains were Escherichia coli - 13.77% (including 22.1% of ESBL strains), Klebsiella penumoniae - 4.6% (44.4% of ESBL strains, 1.85% of NDM strains), Enterobacter cloacae - 2 .7% (including 40.6% of multi-resistant strains: ESBL (15.6%) or with AmpC derepression (25%), among the non-fermenting bacilli, Pseudomonas aeruginosa was the most frequently cultured - 4.18% (including 3.8% MBL) and Acinetobacter baumannii - 0.8% (including CRAB strains 50%, MBL 10%). Anaerobic microorganisms were responsible for 3.46% of blood infection cases. Yeast- like fungi were a factor in 2.7% of all fungemia cases. From blood samples taken Staphylococci were more frequently isolated directly from a vein or through a central venous catheter than aerobic Gram-negative bacilli (44.7% and 25.3% and 55.6% and 12.5%, respectively). The opposite situation occurred in the case of samples taken simultaneously directly from vein and through a central venous catheter, in which a higher share of aerobic Gram-negative bacilli (46.6%) than staphylococci (32.8%) in causing blood infections was observed. Gram-positive bacteria are the major contributors to bloodstream infections in cancer patients. There is a growing tendency to develop BSI caused by multi-resistant strains.

Vancomycin versus daptomycin for the treatment of confirmed gram-positive catheter-related bloodstream infections in oncology patients

ObjectiveTo analyse the effectiveness and safety of daptomycin versus vancomycin on the management catheter-related bloodstream infections in oncology patients. MethodA retrospective study was carried out including all patients admitted at the Medical Oncology Unit between 2010 and 2018 with positive blood cultures confirmed catheter-related bloodstream infections due to gram-positive microorganism, who were treated with either vancomycin or daptomycin. The primary end point was all cause 30-days mortality, 30-days hospital readmission and length of hospital stay (length of hospital stay). ResultsA total of 70 patients with catheter-related bloodstream infections were included in the present study: vancomycin was administered to 61.4% (n = 43) and daptomycin to 38.6% (n = 27) of patients. 78.5% (n = 55) of isolated bacteria showed a vancomycin minimum inhibitory concentration ≤ 1 µg/ml. No differences were observed between the two groups of patients regarding the 30-day mortality rate rate (32.6% [n = 14] versus 29.6% [n = 8]; p = 0.797), the 30-day re-admission rate (30.2% [n = 13] versus 29.6°% [n = 8]; p = 0.957) or the length of hospital stay (18.9 versus 16.5 days; p = 0.562). Nephrotoxicity rate was equivalent in both groups: a 7% (n = 3) of vancomycin goup versus a 7.4% (n = 2) of daptomycin group (p = 0.946). ConclusionsOur results show that both antibiotics are equivalent in their safety and effectiveness. Therefore, vancomycin should continue being the treatment of chose for gram-positive catheter-related bloodstream infections, in particular at hospital centres with a low prevalence of strains that show diminished susceptibility to vancomycin.

Alarming Increase of Azole-Resistant Candida Causing Blood Stream Infections in Oncology Patients in Egypt

Candidemia is a life-threatening invasive fungal infection in immunocompromised patients. The widespread use of azoles and the shift toward non-albicans Candida (NAC) species remarkably increase azole resistance in developing countries. We aimed to study candidemia trends and associated risk factors in oncology patients since they vary geographically, and rapid and appropriate treatment improves outcomes. Vitek 2 was used to identify the Candida species, and the E-test determined their susceptibility to azoles. Candida was the cause of 3.1% (n = 53/1701) of bloodstream infections (BSIs) during a 1-year study. Candida tropicalis was the most predominant species among the 30 candidemia episodes studied (36.7%), followed by C. albicans (33.3%). However, C. krusei, C. guilliermondii, C. pelliculosa, C. parapsilosis, C. famata, and C. inconspicua accounted for 30.0% of the isolates. An increased risk of NAC BSI was significantly associated with chemotherapy and leucopenia (P = 0.036 and 0.016, respectively). However, the multivariable analysis revealed that leucopenia was the only independent risk factor (P = 0.048). Fluconazole and voriconazole resistance were 58.3% and 16.7%, with NAC species showing higher resistance rates than C. albicans. Both fluconazole and voriconazole minimum inhibitory concentration (MIC) median values were higher in NAC than in C. albicans, but only voriconazole was significantly higher (0.220 versus 0.048 μg/ml, P = 0.047). In conclusion, the increased prevalence of NAC BSIs and incredibly high fluconazole resistance rates in cancer patients emphasize the necessity of antifungal stewardship to preserve voriconazole effectiveness, continued surveillance of candidemia, and future studies into azole resistance molecular mechanisms.

Clinical infections in neurosurgical oncology: An overview.

Central nervous system (CNS) infections are urgent conditions with high morbidity and mortality. Bacteria, viruses, parasites or fungi can cause them. Intracranial infections after craniotomies are an important complication of treatment, especially in oncological patients that are already immunologically compromised due to the disease and treatment. The consequence of CNS infections in oncological patients includes longer treatment with antibiotics, additional surgical procedures, higher treatment costs and poorer treatment outcomes. Additionally, the management of primary pathology may be prolonged or postponed as a result of the active infection. By introducing new and improved protocols, tightening controls on their implementation, constantly educating the entire team involved in patient treatment and educating both patients and relatives, the incidence of infections can be reduced effectively.

Bioactive plantaricins as potent anti-cancer drug candidates: double docking, molecular dynamics simulation and in vitro cytotoxicity analysis

The medical community is desperate for a reliable source of medications to alleviate the severity of conventional cancer treatments and prevent secondary microbial infections in oncological patients. In this regard, plantaricins from lactic acid bacteria were explored as prospective drug candidates against known anti-cancer drug targets. Three plantaricins, JLA-9, GZ1-27 and BN, have a binding affinity of −8.8, −8.6 and −7.2 kcal/mol, respectively, with squalene synthase (SQS), a key molecule in lung cancer metastasis. All three plantaricins displayed analogous binding patterns as SQS inhibitors and generated hydrogen and hydrophobic interactions with ARG 47, ARG 188, PHE24, LEU183 and PRO292. Structural stability of docked complexes was validated using molecular dynamics simulation derived parameters such as RMSD, RMSF and radius of gyration. Based on MD simulation results, conformational changes and stabilities of docked SQS/plantaricin complexes with respect to the time frame were evaluated using machine learning (logistic regression algorithm). Double docking with SQS/matrix metalloproteinase MMP1 and PCA analysis revealed the potential of plantaricin JLA-9 as a multi-substrate inhibitor. Further, plantaricin JLA-9 induced a significant cytotoxic response against the lung carcinoma cell line (A549) in a dose and time dependent manner with inhibition concentration (IC50) of 0.082 µg/ml after 48 h. However, plantaricin JLA-9 did not induce cytotoxicity in normal lung cells (L-132), as the IC50 value was not obtained even at a higher dose of 0.8 µg/ml. In silico pharmacokinetic (ADMET) profile implies that plantaricin JLA-9 could be developed as new age anti-cancer therapeutic with a preference for parenteral administration.Communicated by Ramaswamy H. Sarma

Impact of COVID-19 pandemic on therapy in cancer patients

Introduction and purpose: The Covid-19 pandemic has spread rapidly across the globe, resulting in more than 6 million deaths worldwide. Oncological patients are considered to be at increased risk of SARS-CoV-2 coronavirus infection and the severe course of the disease. The current understanding of the correlation between COVID-19 and cancer is limited. In this study, we attempted to analyze the course of SARS-CoV-2 infection in cancer patients who were treated at the Department of Clinical Oncology and Chemotherapy SPSK4 in Lublin in the period from November 2020 to March 2022. &#x0D; Material and methods: This retrospective study included patients in the age rage from 36–79 years old. All necessary information were obtained from electronic medical records. Subsequently collected data were submitted to statistical calculations. &#x0D; Results: A varied course of COVID-19 infection in oncology patients has been observed. Preliminary observations showed that, in many cases COVID-19 infection caused a delay in the administration of the next dose of a therapeutic agent during the course of systemic anticancer treatment, but this delay was not observed to have a significant impact on reducing the effectiveness of oncology treatment &#x0D; Conclusions: In the light of our own presented observations, global statistics and reports of other authors, the role of certain individual characteristics of patients is visible, which increase the risk of more severe course of SARS-CoV-2 infection and / or increased mortality . It is necessary to continue the search for an optimal diagnostic regimen that would identify cancer patients with a particular risk of the most severe complications of SARS-CoV-2 infection.

Predictors of Septic Shock or Bacteremia in Children Experiencing Febrile Neutropenia Post-Chemotherapy.

Febrile neutropenia (FN) is an early indicator of infection in oncology patients post-chemotherapy. We aimed to determine clinical predictors of septic shock and/or bacteremia in pediatric cancer patients experiencing FN and to create a model that classifies patients as low-risk for these outcomes. This is a retrospective analysis with clinical data of a cohort of pediatric oncology patients admitted during July 2015 to September 2017 with FN. One FN episode per patient was randomly selected. Statistical analyses include distribution analysis, hypothesis testing, and multivariate logistic regression to determine clinical feature association with outcomes. A total of 865 episodes of FN occurred in 429 subjects. In the 404 sampled episodes that were analyzed, 20.8% experienced outcomes of septic shock and/or bacteremia. Gram-negative bacteria count for 70% of bacteremias. Features with statistically significant influence in predicting these outcomes were hematological malignancy (P < .001), cancer relapse (P = .011), platelet count (P = .004), and age (P = .023). The multivariate logistic regression model achieves AUROC = 0.66 (95% CI 0.56-0.76). The optimal classification threshold achieves sensitivity = 0.96, specificity = 0.33, PPV = 0.40, and NPV = 0.95. This model, based on simple clinical variables, can be used to identify patients at low-risk of septic shock and/or bacteremia. The model's NPV of 95% satisfies the priority to avoid discharging patients at high-risk for adverse infection outcomes. The model will require further validation on a prospective population.

MO22-3 Gravity of COVID-19 infection in oncology patients undergoing active treatment, a Romanian Cancer Center experience

COVID-19 pandemic had a great impact on the way we deal with oncology patients. One of the compulsory methods to restrain the spread of the virus implemented by Romanian Ministry of Health in April 2020 was the compulsory PCR COVID-19 screening test for all asymptomatic patients undergoing chemotherapy, molecular treatment or immunotherapy, 24-48 hours before the beginning of treatment.

Pseudomonas aeruginosa Infections in Cancer Patients

Pseudomonas aeruginosa (P. aeruginosa) is one of the most frequent opportunistic microorganisms causing infections in oncological patients, especially those with neutropenia. Through its ability to adapt to difficult environmental conditions and high intrinsic resistance to antibiotics, it successfully adapts and survives in the hospital environment, causing sporadic infections and outbreaks. It produces a variety of virulence factors that damage host cells, evade host immune responses, and permit colonization and infections of hospitalized patients, who usually develop blood stream, respiratory, urinary tract and skin infections. The wide intrinsic and the increasing acquired resistance of P. aeruginosa to antibiotics make the treatment of infections caused by this microorganism a growing challenge. Although novel antibiotics expand the arsenal of antipseudomonal drugs, they do not show activity against all strains, e.g., MBL (metalo-β-lactamase) producers. Moreover, resistance to novel antibiotics has already emerged. Consequently, preventive methods such as limiting the transmission of resistant strains, active surveillance screening for MDR (multidrug-resistant) strains colonization, microbiological diagnostics, antimicrobial stewardship and antibiotic prophylaxis are of particular importance in cancer patients. Unfortunately, surveillance screening in the case of P. aeruginosa is not highly effective, and a fluoroquinolone prophylaxis in the era of increasing resistance to antibiotics is controversial.

Clinical impact of SARS-CoV-2 delta variant infection in tumor patients and the impact of vaccination on different cancer treatment regimens.

e18750 Background: Data on SARS-CoV-2 infections in oncological patients in the outpatient settings are scarce. Methods: During the spread of the delta variant between April 2021 and September 2021, a total of 10.677 patients were tested for SARS-CoV-2 infection by RT-qPCR in seven outpatient clinics in Bavaria, Germany. Results: Within the tested patient cohort, 4.960 patients (46.5%) suffered from a malignant disease (74% solid tumors and 26% malignant hematological diseases). This group was compared with 5.717 patients (53.5%) without a malignant disease (33.1% with other hematological diseases and 66.9% patients without a hematological or oncological disease). During the observation period, 119 (2.4%) patients with malignancies were tested positive (88 patients with solid tumors; 31 patients with malignant hematological diseases) compared to 115 positive patients (2.0%) in the control group. 32 of 119 positively tested patients (26.9%) suffering from malignant disease required hospitalization and 9/32 patients (28.1%) died during the clinical course. Conclusions: These observations are in clear contrast to data from patients we evaluated during the pre-delta variants period between 15 and 26 April 2020 in the same seven outpatient clinics. In this period, a total of 1.227 patients were tested for SARS-CoV-2 by RT-qPCR. 78/1227 patients (6.3%) were tested positive in RT-qPCR and most showed mild symptoms of infection. None of the SARS-CoV-2 infected patients died. These data were analyzed when no vaccination was available. These data were evaluated during a period where no vaccine was available. Vaccination of patients with malignancies with BiontechPfizer's mRNA vaccines was started in April 2021. The response to the vaccine was tested by an antibody assay (Elecsys Anti-SARS-CoV-2 S-immunoassay, Roche) at the earliest four weeks after the second vaccination. To assess the response, we compared five patient cohorts: Patients who received (i) B cell depleting antibodies, (ii) checkpoint inhibitors (ICI), (iii) chemotherapy, or (iv) tyrosin kinase inhibitors (TKIs), and (v) healthy controls. The patients treated with ICI or TKI showed a comparable vaccination response to the healthy patients, while patients receiving Rituximab/Obinutuzumab showed no significant humoral vaccination response at all. The more severe disease course of patients infected by the SARS-CoV-2 delta variant compared to the initial waves of infections strongly underline the importance of vaccination in cancer patients.

#38: Bacteremia Analysis of Three Hospitals in Hispaniola Island

Abstract Background In October 2018, the Hispaniola Project was initiated to build local expertise in infection care and prevention at three pediatric oncology units (POUs) in Haiti and the Dominican Republic. Surveillance of healthcare-associated infections (HAI) was a central aim. Severe and prolonged neutropenia is a frequent risk factor for infections in oncology patients. Among HAIs, bacteremia is one of the most serious; bacteremia requires timely isolation and identification of the offending microorganism and the antimicrobial susceptibility. These diagnostic interventions allow informed therapeutic and prophylactic measures. Here, we report our experience in bacteremia in these 3 POUs. Methods We conducted prospective infection surveillance of all patients admitted to three POUs in Hispaniola Island. Blood culture methods followed standard national procedures. We used the 2018 US Centers for Disease Control National Healthcare Safety Network case definitions for primary laboratory-confirmed bloodstream infections (LCBI), and we categorized infections as healthcare-associated or present on admission (POA). We reviewed data collected from January 2019 to December 2020 and used descriptive statistics to report our results. Results Our review identified 66 LCBIs with an overall rate of 3.52 infections per 1000 patient-days. Of these, 40 (61%) were healthcare-associated, and 26 were POA. The majority (41, 62%) of patients were undergoing chemotherapy at the time of the infection, with induction being the most common phase (23). The most common oncologic diagnosis was acute lymphoblastic leukemia (43, 65%), followed by solid tumor (12, 18%). Fifty-three (80%) of the infections met the LCBI-1 criteria, with the other 13 categorized as LBCI-2. Of the 53 LCBI-1, 7 (13%) were considered related to mucosal barrier injury (MBI-LCBI 1 definition). The most commonly identified organisms were Klebsiella spp. (13, 19%) and coagulase-negative Staphylococcus (13, 19%). Antibiotic resistance was observed in many of the identified pathogens, with nearly half (25, 44%) of the 57 bacterial isolates having any resistance and a quarter (14, 25%) with resistance to multiple classes, including cephalosporins, fluoroquinolones, and aminoglycosides. Eleven (17%) patients were admitted to the Intensive Care Unit as a result of the LCBI. Thirteen deaths were recorded among the patients with LCBIs, with 6 (46%) associated with the HAI and 7 (54%) related to disease progression. Conclusions Our findings demonstrate that resistant pathogens were frequent among the LCBI isolates. Our preliminary results are guiding clinical management to be vigilant in our care of patients at high risk for bacteremia and poor clinical response by initiating more effective antimicrobials sooner. Importantly, reviewing reasons for antimicrobial resistance and implementing best antimicrobial use practices will protect our fragile antibiotic arsenal. Infection surveillance programs, such as ours, and other initiatives which promote infection prevention and control in POU will increase the quality of care for these vulnerable patients.

P174 - Our experience with COVID-19 infection in oncology patients

P174 - Our experience with COVID-19 infection in oncology patients

Correlation of Positive Blood Cultures with Peripherally Inserted Central Catheter Line Infection in Oncology Patients.

Introduction: The use of peripherally inserted central catheter (PICC) lines offers several advantages compared to traditional central venous catheters (CVCs) as the insertion procedure is minimally invasive, they may be retained safely for longer periods of time, and their use is associated with fewer catheter-related infections. Their use in patients suffering from a malignant disease is common but may pose a greater risk of complications due to the severe immunosuppression associated with treatment. This study was conducted to evaluate the safety of PICC lines in this group.Methods: This was a retrospective study of oncology patients being treated in a Mediterranean tertiary center. Patients with PICC lines were enrolled in the study if a positive blood culture necessitated the removal of the PICC and subsequent culture of the PICC tip. A comparison was conducted between patients with positive and negative PICC cultures.Results: Thirty patients were included, four of whom had a positive PICC culture. The most commonly isolated pathogens were coagulase-negative Staphylococci and Corynebacteria. No statistically significant difference was noted in white blood cell (WBC) counts, C-reactive protein (CRP), and Michigan PICC central line associated bloodstream infection (MPC) score between the two groups. Staphylococcus epidermidis was the most commonly isolated pathogen.Discussion: Though limited by a small sample size and the retrospective design, the findings of this study seem to corroborate existing literature on the subject which suggests that the use of PICC lines in oncology patients is feasible and does not pose unacceptable risk. Further research is indicated to determine subgroups which may be at greater risk of PICC related infections.

Distribution of Pathogens Involved in Infections in Oncological Patients and their Antibiotic Resistance Profile

Cancer is the second leading cause of death in Romania and worldwide. Cancer patients are at increasing risk of acquiring bacterial infection with multi-resistant germs, including multidrug-resistant (MDR) strains of Gram-negative bacteria involved in nosocomial infection. Romania is one of the South-Eastern European countries with one of the highest prevalence rates of MDR pathogens. To determine the resistance pattern of bacterial profile and antibiotic resistance pattern in cancer patients admitted at the County Emergency Clinical Hospital Craiova, Romania. A retrospective study of bacterial pathogens was carried out on 90 adult cancer patients admitted from January to December 2018. The analysis of the resistance patterns for the action of the appropriate antibiotics was performed using Vitek 2 Compact system and diffusion method. In this study there were analysed 92 samples from 90 oncological patients (37-86 years). A total of 157 bacterial isolates were obtained, of which 37 strains of Staphylococcus aureus (23.56%), followed by Streptococcus pneumoniae (23- 14.64%), Klebsiella spp. and Escherichia coli (22 - 14,01%). The most common isolates were from respiratory tract (86 isolates - 54.77%). High rates of MDR were found for E. coli (63.63%), MRSA (61,11%) and Klebsiella spp. (54,54%), while one third of the isolated strains of Pseudomonas aeruginosa, Acinetobacter spp. and Proteus spp. were MDR. The findings of this study may be the basis for further more extensive studies highlighting the germs involved in the infectious pathology of cancer patients, in order to determine the antimicrobial resistance and to improve the methods of prophylaxis and treatment. Keywords: multidrug resistance (MDR), cancer patients, bacterial pathogen

Epidemiology, Diagnosis, Treatment, and Prevention of Influenza Infection in Oncology Patients.

Influenza infection causes increased morbidity and higher mortality in patients receiving treatment of underlying cancer, particularly in those with hematological malignancy or patients who have undergone hematopoietic stem-cell transplantation. The illness is characterized by seasonality and nonspecific clinical manifestations of upper respiratory infection at a time when other respiratory illnesses are common in the community, making the diagnosis challenging. However, accurate and timely diagnosis by new molecular techniques is crucial in the management of immunocompromised patients, because delays in initiating appropriate therapy can have devastating consequences. Emergence of viral resistance to currently used antiviral agents is of concern, particularly in immunocompromised hosts, and warrants continued monitoring and surveillance. Early and effective treatment improves outcomes, but optimal therapeutic strategies in patients with cancer are not well defined. Health care and research efforts should focus on defining treatment guidelines in patients with cancer and attempt to improve on current vaccination strategies.

Epidemiology of invasive infections caused by vancomycin sensitive and resistant enterococcal strains among oncology patients at the National Cancer Institute of Sri Lanka from 1st of July 2012 to 31st of July 2013

Introduction and Objectives: Enterococci have traditionally been regarded as low grade pathogens but have emerged as an increasingly important cause of nosocomial infections in the last decade. While the Enterococcus faecalis remains the predominate species in clinical infection, Enterococcus faecium isolates are increasing in proportion. This study was carried out to describe the epidemiology of invasive enterococcal infections among oncology patients at the National Cancer Institute of Sri Lanka (NCISL). Methods: 60 patients with invasive enterococcal infections, who were treated as inward patients at the National Cancer Institute of Sri Lanka from 1.7.2012 to 31.7 21013 whose samples were sent for microbiological investigation were included in this study. Speciation of the isolates was done by using a rapid manual analytic system (RapID STR panel-Oxoid). Vancomycin sensitivity was assessed in all enterococcal isolates by disc diffusion method, agar dilution screening method (CLSI guideline 2013)16 and detection of minimum inhibitory concentration (MIC) by using Vancomycin gradient strips. Teicoplanin MIC was assessed only in vancomycin resistant isolates using teicoplanin gradient strips. Associated factors for getting an infection with vancomycin resistant strains were assessed using a data extraction sheet. Results: The incidence of invasive enterococcal infections among oncology patients was 1.1 per 1000 admissions. The incidence of invasive enterococcal infection caused by vancomycin resistant species was 0.16 per 1000 admissions. E. faecium was the dominant species causing invasive enterococcal infections (55%). Using the gradient strip method for determination of vancomycin MIC as the gold standard, the screening agar dilution method had 100% sensitivity and specificity and the disc diffusion test had a low specificity (77.8%). Almost all the participants (96.6%) had acquired the enterococcal infection from the hospital. Vancomycin resistant infections were more common in patients who had haematological malignancies, who were treated with 3rd generation cephalosporins and cytotoxic chemotherapy drugs. Conclusions: E. faecium is the dominant species causing invasive enterococcal infections in oncology patients (55%) and phenotypically compatible with the VanA phenotype of glycopeptide resistant enterococci.

Bloodstream infections in oncology patients at Red Cross War Memorial Children’s Hospital, Cape Town, from 2012 to 2014

ObjectivesThis study was performed to investigate the epidemiology of bloodstream infection (BSI) in oncology patients at Red Cross War Memorial Children’s Hospital (RCWMCH), Cape Town, with focus placed on the most common causes, complications, and antimicrobial susceptibilities in BSI. MethodsA retrospective cross-sectional study was conducted in the Haematology–Oncology Unit of RCWMCH. All positive blood cultures from RCWMCH oncology patients obtained in 2012 to 2014 were retrieved to identify cases of BSI. ResultsThree hundred and forty-three positive cultures were identified, for 150 BSI episodes among 89 patients; 49.1% of the culture isolates were Gram-positive bacteria, 41.6% were Gram-negative bacteria, and 9.3% were fungal. Coagulase-negative Staphylococcus and viridans group Streptococcus were the most common Gram-positive isolates. Escherichia coli and Klebsiella species were the most common Gram-negative isolates. The majority of BSI episodes occurred in patients with haematological malignancies (74%), in the presence of severe neutropenia (76.4%), and were associated with chemotherapy (88%). Complications occurred in 14% of BSI. Fungal infections had the highest prevalence of complications (21.4%). Three children died during BSI, giving a case-fatality rate of 2%. ConclusionsBSI in these patients was caused mainly by Gram-positive bacteria and was associated with a low case-fatality rate. These results are consistent with worldwide experience of BSI in paediatric oncology.