Antibiotic Susceptibility Pattern of Bacteria Isolated from Blood Cultures of Febrile and Neutropenic Patients

Document Type : Original Article (s)

Authors

1 Assistant Professor of Infectious Diseases, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Medical Student, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jims.v43.i826.0926

Abstract

Background: The relationship between fever and neutropenia and the risk of life-threatening infections in patients undergoing cytotoxic chemotherapy is well established, and infectious complications are the main cause of mortality in these patients. This study aimed to determine the frequency of bacteria isolated from blood cultures and their antibiotic susceptibility patterns in febrile and neutropenic patients admitted to Seyed Al-Shohada Hospital, Isfahan.
Methods: This cross-sectional study included 364 patients with confirmed febrile neutropenia admitted to Seyed Al-Shohada Hospital in 2019-2020 through census sampling. Data were collected using a checklist and analyzed with Mann-Whitney and Chi-square tests.
Findings: The most common gram-positive bacteria isolated from blood cultures were Staphylococcus epidermidis (22.8%, n = 83), while the most common gram-negative isolates were Escherichia coli (23.6%, n = 86) and Klebsiella species (16.8%, n = 61). There was no significant difference in the distribution of isolated bacteria by gender (P < 0.05). Overall, gram-positive bacteria showed highest susceptibility to erythromycin, while gram-negative isolates were most susceptible to amikacin, cefepime, and piperacillin-tazobactam. The highest resistance in gram-positive bacteria was observed against amikacin, meropenem, piperacillin-tazobactam, imipenem, and linezolid, while gram-negative bacteria showed maximum resistance to clindamycin, erythromycin, oxacillin, penicillin, levofloxacin, tetracycline, vancomycin, ampicillin, imipenem, and linezolid.
Conclusion: Determining regional antibiotic susceptibility patterns of prevalent organisms and communicating these to physicians can facilitate more effective empirical treatment.

Highlights

Somayeh Haghighipour : Google Scholar

Keywords

Main Subjects


  1. Villafuerte-Gutierrez P, Villalon L, Losa JE, Henriquez-Camacho C. Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update. Adv Hematol 2014; 2014: 986938.
  2. Rivera-Salgado D, Valverde-Muñoz K, Ávila-Agüero ML. [Febrile neutropenia in cancer patients: management in the emergency room]. [in Spanish]. Rev Chilena Infectol 2018; 35(1): 62-71.
  3. Yapici O, Gunseren F, Yapici H, Merdin A, Yaylali Ü, Merdin FA. Evaluation of febrile neutropenic episodes in adult patients with solid tumors. Mol Clin Oncol 2016; 4(3): 379-82.
  4. Lucas AJ, Olin JL, Coleman MD. Management and Preventive Measures for Febrile Neutropenia. PT 2018; 43(4): 228-32.
  5. Davis K, Wilson S. Febrile neutropenia in paediatric oncology. Paediatr Child Health (Oxford) 2020; 30(3): 93-7.
  6. Lehrnbecher T, Robinson P, Fisher B, Alexander S, Ammann RA, Beauchemin M, et al. Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update. J Clin Oncol 2017; 35(18): 2082-94.
  7. Paolino J, Mariani J, Lucas A, Rupon J, Weinstein H, Abrams A, et al. Outcomes of a clinical pathway for primary outpatient management of pediatric patients with low-risk febrile neutropenia. Pediatr Blood Cancer 2019; 66(7): e27679.
  8. Hansen BA, Wendelbo Ø, Bruserud Ø, Hemsing AL, Mosevoll KA, Reikvam H. Febrile Neutropenia in Acute Leukemia. Epidemiology, Etiology, Pathophysiology and Treatment. Mediterr J Hematol Infect Dis 2020; 12(1): e2020009.
  9. Kim M, Ahn S, Kim WY, Sohn CH, Seo DW, Lee YS, et al. Predictive performance of the quick Sequential Organ Failure Assessment score as a screening tool for sepsis, mortality, and intensive care unit admission in patients with febrile neutropenia. Support Care Cancer 2017; 25(5): 1557-62.
  10. Lakshmaiah KC, Malabagi AS, Govindbabu, Shetty R, Sinha M, Jayashree RS. Febrile Neutropenia in Hematological Malignancies: Clinical and Microbiological Profile and Outcome in High Risk Patients. J Lab Physicians 2015; 7(2): 116-20.
  11. Menzo SL, la Martire G, Ceccarelli G, Venditti M. New Insight on Epidemiology and Management of Bacterial Bloodstream Infection in Patients with Hematological Malignancies. Mediterr J Hematol Infect Dis 2015; 7(1): e2015044.
  12. Ricciardi W, Giubbini G, Laurenti P. Surveillance and Control of Antibiotic Resistance in the Mediterranean Region. Mediterr J Hematol Infect Dis 2016; 8(1): e2016036.
  13. Hassoun A, Linden PK, Friedman B. Incidence, prevalence, and management of MRSA bacteremia across patient populations-a review of recent developments in MRSA management and treatment. Crit Care 2017; 21(1): 211.
  14. Zhang Y, Zheng Y, Dong F, Ma H, Zhu L, Shi D, et al. Epidemiology of febrile neutropenia episodes with gram-negative bacteria infection in patients who have undergone chemotherapy for hematologic malignancies: a retrospective study of 10 years' data from a single center. Infect Drug Resist 2020; 13: 903-10.
  15. Escrihuela-Vidal F, Laporte J, Albasanz-Puig A, Gudiol C. Update on the management of febrile neutropenia in hematologic patients. Rev Esp Quimioter 2019; 32 Suppl 2(Suppl 2): 55-8.
  16. Micozzi A, Gentile G, Minotti C, Cartoni C, Capria S, Ballarò D, et al. Carbapenem-resistant Klebsiella pneumoniae in high-risk haematological patients: factors favouring spread, risk factors and outcome of carbapenem-resistant Klebsiella pneumoniae bacteremias. BMC Infect Dis 2017;17(1):203.
  17. Robinson PD, Lehrnbecher T, Phillips R, Dupuis LL, Sung L. Strategies for empiric management of pediatric fever and neutropenia in patients with cancer and hematopoietic stem-cell transplantation recipients: a systematic review of randomized trials. J Clin Oncol 2016; 34(17): 2054-60.
  18. Haeusler GM, Sung L, Ammann RA, Phillips B. Management of fever and neutropenia in paediatric cancer patients: room for improvement? Curr Opin Infect Dis 2015; 28(6): 532-8.
  19. Mahmoudi H, Ghasemi Bassir HR, Hosseini SM, Arabestani MR, Alikhani MY. The frequency of bacteria isolated from blood cultures and antibiotic susceptibility patterns among admitted patients in Hospital of Hamadan University of Medical Sciences [in Persian]. Iran J Med Microbiol 2016; 10(4): 69-74.
  20. Saderi H, Karimi Aa, Loni M. Study of frequency of bacteria isolated from blood culture and their antibiotic susceptibility pattern in a university hospital in Tehran [in Persian]. Iran South Med J 2009; 12(2): 142-8.
  21. Roohi S, Mohammadi B, Ramazanzadeh R, Mohammadi S, Zandi S. Prevalence of isolated bacterial and antibiotic resistant pattern of them in positive blood cultures isolated from patients admitted to different parts of Toohid Hospital of Sanandaj city (2013-2014) [in Persian]. Navid No Journal 2015; 18(60): 34-41.
  22. Babu KG, Lokanatha D, Lakshmaiah KC, Suresh Babu MC, Jacob LA, Bhat GR, et al. Bloodstream infections in febrile neutropenic patients at a tertiary cancer institute in South India: A timeline of clinical and microbial trends through the years. Indian J Med Paediatr Oncol 2016; 37(3): 174-82.
  23. Stergiotis M, Ammann RA, Droz S, Koenig C, Agyeman PKA. Pediatric fever in neutropenia with bacteremia-Pathogen distribution and in vitro antibiotic susceptibility patterns over time in a retrospective single-center cohort study. PLoS One 2021; 16(2): e0246654.
  24. James V, Prakash A, Mehta K, Durugappa T. Re-thinking treatment strategies for febrile neutropenia in paediatric oncology population: the perspective from a developing country. Infect Agent Cancer 2021; 16(1): 44.
  25. Sorsa A, Früh J, Stötter L, Abdissa S. Blood culture result profile and antimicrobial resistance pattern: a report from neonatal intensive care unit (NICU), Asella teaching and referral hospital, Asella, south East Ethiopia. Antimicrob Resist Infect Control 2019; 8: 42.
  26. Khan MS, Kareem A, Fatima K, Rauf S, Khalid A, Bashir MS. Microbial Patterns and Antibiotic Susceptibility in Blood Culture Isolates of Septicemia Suspected Children in the Pediatrics Ward of a Tertiary Care Hospital. J Lab Physicians 2021; 13(1): 64-9.
  27. Almohammady MN, Eltahlawy EM, Reda NM. Pattern of bacterial profile and antibiotic susceptibility among neonatal sepsis cases at Cairo University Children Hospital. J Taibah Univ Med Sci 2020; 15(1): 39-47.
  28. Wattal C, Goel N. Pediatric blood cultures and antibiotic resistance: an overview. Indian J Pediatr 2020; 87(2): 125-31.
  29. Ejaz A, Khawaja A, Arshad F, Tauseef A, Ullah R, Ahmad I. Etiological profile and antimicrobial patterns in blood culture specimens in a tertiary care setting. Cureus 2020; 12(10): e11000.
  30. Moremi N, Claus H, Mshana SE. Antimicrobial resistance pattern: a report of microbiological cultures at a tertiary hospital in Tanzania. BMC Infect Dis 2016; 16(1): 756.