Retrospective Analysis of Bacterial Isolates during Blood Stream Infections in Children with Chemotherapy-induced Febrile Neutropenia: A Single Centre Experience

Abstract Introduction The recent advances in cancer treatment have resulted in significant improvement in the outcome of pediatric cancers. However, febrile neutropenia (FN) is the most important cause of mortality and morbidity in pediatric cancer patients and is a crucial limiting factor for the outcome. The greatest threat that we are facing is the emergence of pan drug-resistant (PDR) organisms. Objectives To study bacterial organisms causing bloodstream infections (BSI) during febrile neutropenia episodes, their antibiotic sensitivity pattern, impact on treatment outcome during the intensive phase of chemotherapy, and the association between prior administration of antibiotics and emergence of multidrug-resistant organisms (MDR). Materials and Methods This retrospective study was conducted in patients between the age group of 0 to 18 years who were treated for malignancies in the division of pediatric oncology at a tertiary center from August 2017 to December 2020. Blood cultures were collected under aseptic precautions, and they were processed as per the Clinical and Laboratory Standard Institute Guideline (CLSI) 2017. Results A total of 122/159 (76.7%) patients were diagnosed to have hematological malignancies, and 37/159 (23.3%) patients were found to be suffering from solid tumors. A total of 309 episodes of FN were documented and 386 cultures were sent, out of which 87/386 (22.53%) cultures were positive for bacteria and 2/386 (2.2%) for fungi. Gram-negative isolates were seen in 51/87 (58.62%) cultures and Gram-positive in 36/87 (41.37%) cultures. Burkholderia cepacia and coagulase-negative Staphylococci (CONS) were the commonest found Gram-negative and Gram-positive bacteria, respectively. MDR bacterial strains were seen in 44/87 (50.57%) cultures and PDR strains in 8/87 (9.2%) cultures. Resistance was higher with Klebsiella species and CONS. There were six mortalities during the induction phase of acute leukemia treatment, out of which 4/6 (66.66%) were due to MDR infections, 1/6 (16.6%) due to fungal infection and chemotherapy refractoriness each. Conclusion Proven bacterial infections were determined in 22.53% of febrile neutropenia episodes. Most BSI in patients with febrile neutropenia were caused by Gram-negative bacteria. Indiscriminate use of higher antibiotics before referral led to the emergence of MDR organisms, thus compromising the outcome. Our study emphasizes the fact that antibiotic stewardship is a crucial task to counter MDR bacteremia-related morbidity and mortality in neutropenic children.

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Prevalence and Antibiotic Sensitivity pattern of Bacterial Isolates from Catheterized UTI Patients: A Local Study

Pakistan Journal of Biochemistry and Biotechnology ◽

10.52700/pjbb.v2i2.88 ◽

2021 ◽

Vol 2 (2) ◽

pp. 229-235

Author(s):

Iqra Arooj ◽

Alishba Sehar ◽

Asghar Javaid

Keyword(s):

Bacterial Infections ◽

Bacterial Species ◽

Local Population ◽

Bacterial Isolates ◽

Biochemical Tests ◽

Gram Positive ◽

Local Study ◽

Gram Negative ◽

Sensitivity Pattern ◽

Tract Infections

Prevalence and multidrug resistance among bacteria in catheter-associated urinary tract infections (CAUTIs) has been on the rise in recent times. Hence, the prevalence rate and antibacterial susceptibility of bacteria in CAUTIs in ICU patients was evaluated. A total of 120 patients admitted to the ICU of Nishtar Hospital, Multan, were recruited for this study. Both gram-positive and gram-negative bacterial isolates were characterized based on biochemical tests including catalase test, oxidase test, indole test, TSI test, citrate test, coagulase test and growth on 6.5% NaCl agar. The prevalence of bacterial species was Escherichia coli (32%), Staphylococcus aureus (26%), Pseudomonas spp. (18%), Proteus spp. (14%) and Enterococcus spp. (2%). A considerable degree of resistance against commonly prescribed antibiotics was observed. Gram negative bacteria showed resistance to ciprofloxacin, piperacillin-tazobactam and amikacin as well as susceptibility to imipenem, tigecycline and polymixin. Gram positive bacteria showed resistance to antibiotics such as piperacillin-tazobactam, ampicillin, gentamicin, oxacillin and ceftazidime suggesting the ineffectiveness of these antibiotics for treating bacterial infections among CAUTI patients and demonstrating the latest trends in antimicrobial drug resistance profile in local population.

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Clinical and Microbiological Profile of Pathogens in Febrile Neutropenia in Hematological Malignancies: A Single Center Prospective Analysis

Journal of Oncology ◽

10.1155/2015/596504 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

M. Taj ◽

T. Farzana ◽

T. Shah ◽

S. Maqsood ◽

S. S. Ahmed ◽

...

Keyword(s):

Febrile Neutropenia ◽

Empirical Treatment ◽

First Line ◽

Gram Positive ◽

Gram Negative ◽

Hematological Disorders ◽

Microbiological Profile ◽

Sensitivity Pattern ◽

Culture Sensitivity ◽

Marked Decline

Background. Febrile neutropenia is the consequence of treatment of hematological disorders. The first-line empirical treatment should cover the prevalent microorganism of the institute. The aim of study was to establish the effectiveness of current practices used at the institution and to review the culture sensitivity pattern of isolated microorganisms.Patients and Methods. Data was recorded and analyzed prospectively for 226 hospitalized patients of febrile neutropenia from January 2011 till December 2013.Results. Out of 226 cases, 173 were males and 53 were females. Clinically documented infections were 104 (46.01%) and microbiologically documented infections were 80 (35.39%), while 42 (18.58%) had pyrexia of undetermined origin. Gram negative infections accounted for 68 (85%) andEscherichia coliwas the commonest isolate. Gram positive microorganisms were isolated in 12 (15%) cases and most common wasStaphylococcus aureus. First-line empirical treatment with piperacillin/tazobactam and amikacin showed response in 184 patients (85.9%) till 72 hours.Conclusion. There is marked decline in infections due to Gram positive microorganisms; however, Gram negative infections are still of great concern and need further surveillance. In this study the antibiogram has shown its sensitivity for empirical antibiotic therapy used; hence, it supports continuation of the same practice.

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Prevalence and effect of bacterial co-infections on clinical outcomes in hospitalized COVID-19 patients at a tertiary care centre of India

10.1101/2021.08.06.21261695 ◽

2021 ◽

Author(s):

Ashutosh Pathak ◽

Sweta Singh ◽

Sanjay Singh ◽

Sangram Singh Patel ◽

Nida Fatima ◽

...

Keyword(s):

Clinical Outcomes ◽

Bacterial Infections ◽

Tertiary Care ◽

Clinical Signs ◽

Antibiotic Sensitivity ◽

Tertiary Care Centre ◽

Gram Positive ◽

Gram Negative ◽

Systematic Testing ◽

Sensitivity Pattern

Abstract Background: Bacterial co-infections are a leading cause of morbidity and mortality during viral infections including COVID-19. Systematic testing of COVID-19 patients having bacterial co-infections is essential to select the correct antibiotic for treatment in order to reduce mortality and also prevent spread of antimicrobial resistance (AMR). The present study aims to evaluate the prevalence, demographic parameters, antibiotic sensitivity patterns and outcomes in hospitalized COVID-19 patients with bacterial co-infections. Methods: A total of 1019 COVID-19 patients were selected for the study. We analyzed the prevalence, antibiotic sensitivity pattern and clinical outcomes in COVID-19 patients having bacterial co-infections. Results: Out of a total 1019 COVID-19 patients screened, 5.2% of patients demonstrated clinical signs of bacterial co-infection. Bacteremia was found in majority of the patients followed by respiratory and urinary infections. Escherichia coli, Pseudomonas aeruginosa and Klebsiella spp. were most common isolates among the Gram-negative and Coagulase-negative Staphylococci (CONS) and Staphylococcus aureus among the Gram-positive bacterial infections. Antibiotic sensitivity profiling revealed that colistin, imipenem and fosfomycin were the most effective drugs against the Gram-negative isolates while vancomycin, teicoplanin and doxycycline against the Gram-positive isolates. Analysis of clinical outcomes revealed that the mortality rate was higher (39%) among the patients with bacterial co-infections as compared to the group without co-infection (17%). Conclusions: This study reveals that the rate of bacterial co-infections is significantly increasing among COVID-19 patients and leading to increase in mortality. Systematic testing of bacterial co-infections is therefore essential in COVID-19 patients for better clinical outcomes and to reduce AMR.

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Microbial Infection with Their Antibiotic Sensitivity Pattern in Febrile Neutropenic Patients Treated in Haematology and BMT Unit in DMCH

Haematology Journal of Bangladesh ◽

10.37545/haematoljbd201823 ◽

2018 ◽

Vol 2 (02) ◽

pp. 42-46

Author(s):

Md. Ashraful Haque Chowdhury ◽

Akhil Ranjan Biswas ◽

Salma Afrose ◽

Mafruha Akhter ◽

Tasneem Ara ◽

...

Keyword(s):

Febrile Neutropenia ◽

Medical College Hospital ◽

Urine Samples ◽

Gram Positive ◽

College Hospital ◽

Gram Negative ◽

Medical College ◽

Sensitivity Pattern ◽

Neutropenic Patients ◽

Blood And Urine Samples

Background: Because of great concerns about mortality and morbidity due to infection in febrile neutropenic patients, the appropriate empirical antibiotic should be started immediately. Although there are established guidelines for the use of empirical therapy in febrile neutropenia, local microbiological pattern and antibiotic susceptibility should be considered for better outcome. There is paucity of data regarding the organism isolated and sensitivity in febrile neutropenic patients in Dhaka Medical College Hospital (DMCH). Objectives: The current study aimed to find out causative organisms for febrile neutropenia and to observe their antimicrobial sensitivity pattern. Materials and method: This was a prospective observational study carried out in department of haematology and BMT of Dhaka Medical college hospital during the period of October, 2014 to July, 2015. Total 104 patients experienced febrile neutropenia and both febrile blood and urine samples were collected and sent for culture. Results: Out of 104 patients male were 65 and female were 39 (M:F ratio 1.6:1) with a mean age of patients were 31.3 (±15.43) years. Majority (86.5%) of febrile neutropenic patients were post-chemotherapy of acute leukaemia. Out of 104 case 29 were positive growth in both blood and urine samples. Out of 25 blood culture positive patients’ organisms isolated were predominantly gram negative (78.6%) whereas 21.4% were gram negative. However, in urine culture equal number of organisms (4 vs 4) from both gram positive and gram negative were isolated. Gram negative microorganisms were resistance to antibiotic such as amoxicillin, ceftazidime, ceftriaxone, cefixime, cotrimoxazole and gentamicin and sensitive to antibiotic like meropenem, amikacin, ciprofloxacin and colistin. Gram positive microorganisms were almost resistance to azithromycin, cefixime, ciprofloxacin, cotrimoxazole, gentamicin and moxifloxacin but were sensitive to chloramphenicol, clindamycin and linezolid. Conclusions: Gram negative organisms were the predominant organisms in febrile neutropenic patients at our institute. They are resistant to a good number of commonly used antibiotics and sensitive to only a few antibiotics.

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Fusogenic porous silicon nanoparticles as a broad-spectrum immunotherapy against bacterial infections

Nanoscale Horizons ◽

10.1039/d0nh00624f ◽

2021 ◽

Author(s):

Byungji Kim ◽

Qinglin Yang ◽

Leslie W. Chan ◽

Sangeeta N. Bhatia ◽

Erkki Ruoslahti ◽

...

Keyword(s):

Porous Silicon ◽

Broad Spectrum ◽

Therapeutic Efficacy ◽

Bacterial Infections ◽

Silicon Nanoparticles ◽

First Line ◽

Gram Positive ◽

Gram Negative ◽

Porous Silicon Nanoparticles

RNAi-mediated immunotherapy provided by fusogenic porous silicon nanoparticles demonstrates superior therapeutic efficacy against both Gram-positive and Gram-negative bacterial infections compared with first-line antibiotics.

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The epidemiology of central venous catheter-related bloodstream infection in our renal units is changing

The Journal of Vascular Access ◽

10.1177/1129729821990222 ◽

2021 ◽

pp. 112972982199022

Author(s):

Salvatore Mandolfo ◽

Adriano Anesi ◽

Vanina Rognoni

Keyword(s):

Burkholderia Cepacia ◽

Present Report ◽

Statistical Significance ◽

Bloodstream Infections ◽

Venous Catheter ◽

Renal Unit ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Over Time

Recent reports have shown an increase in the rate of Gram-negative bacteremia in several settings, including catheter-related bloodstream infections (CRBSI). To analyze if the epidemiology of CRBSI is also changing in hemodialysis patients, we revisited the etiology of CRBSIs in our renal unit over 8 years. During the observed periods, 149 episodes of CRBSIs were reported and the CRBSI incidence rate, ranged between 0.67 and 0.82 episodes/1000 tCVC days. Of these 149 episodes, 84 (56.3%) were due to Gram-positive bacteria, 62 (41.6%) to Gram-negative bacteria, and 3 (2.1%) to polymicrobial flora, no episodes of fungi were found. There was a trend, but not statistically significative, increase over time in the number of Gram-negative CRBSIs among the total CRBSIs, rising from 37.8% in the first period to 41.2% in the second period and to 44.3% in the last period, with a parallel decrease in the percentage of Gram-positive CRBSIs (from 59.5% to 56.9% and subsequently to 54.1%). Between Gram-negative, we reported an intensification of CRBSI due to Enterobacterales, particularly Escherichia coli. Among the Gram-negative, we have isolated germs rarely reported in the literature, such as Burkholderia cepacia, Pantoea agglomerans, and Rhizobium radiobacter. Regarding Gram-positive bacteria, a triplicate incidence of Staphylococcus aureus was reported with MRSA accounting for 42% in the third period. Among the Gram-positive bacteria, we reported two episodes of Kocuria kristinae and two of Bacillus spp. Our data demonstrated that the epidemiology of CRBSI in the same center, will change over time and Gram-negative strains are an increasing cause of CRBSI. The limitation of the present report is that statistical significance has not been reached, probably due to the limited number of CRBSI. New bacteria, both Gram-negative and Gram-positive, are emerging. Collaboration with the Microbiology Department appears essential to an appropriate diagnosis.

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NEW INSIGHT ON EPIDEMIOLOGY AND MANAGEMENT OF BACTERIAL BLOODSTREAM INFECTION IN PATIENTS WITH HEMATOLOGICAL MALIGNACIES

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2015.044 ◽

2015 ◽

Vol 7 ◽

pp. e2015044 ◽

Cited By ~ 5

Author(s):

Sara Lo Menzo ◽

Giulia La Martire ◽

Giancarlo Ceccarelli ◽

Mario Venditti

Keyword(s):

Febrile Neutropenia ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Empirical Treatment ◽

Rational Approach ◽

Attributable Mortality ◽

Low Grade ◽

Gram Positive ◽

Adequate Treatment ◽

Gram Negative

Bloodstream infections (BSI) are an important cause of morbidity and mortality in onco-hematologic patients. The Gram-negative etiology was the main responsible of the febrile neutropenia in the sixties and its impact declined due to the use of fluoroquinolone prophylaxis; this situation was followed by the gradual emergence of Gram-positive bacteria also following of the increased use of intravascular devices and the introduction of new chemotherapeutic strategies. In the last decade the Gram-negative etiology is raising again because of the emergence of resistant strains that make questionable the usefulness of currentstrategies for prophylaxis and empirical treatment. Gram-negative BSI attributable mortality is relevant and the appropriate empirical treatment significantly improves the prognosis; on the other hand the delayed adequate treatment of Gram-positive BSI does not seem to have an high impact on survival. The clinician has to be aware of the epidemiology of his institution and of colonizations of his patients in order to choose the most appropriate empiric therapy. Ina setting of high endemicity of multidrug-resistant infections, even the choice of a targeted therapy can be a challenge, often requiring strategies based on off-label prescriptions and low grade evidences.In this review we summarize the current evidences for the best targeted therapies for difficult to treat bacteria BSIs and future perspectives in this topic. We also provide a flow chart for a rational approach to the empirical treatment of febrile neutropenia in a multidrug resistant high prevalence setting.

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Bacteriological profile and antibiogram of cancer patients admitted in intensive care unit of a tertiary care cancer hospital in central Kerala

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205323 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4450

Author(s):

Sanjana Ramakrishnan ◽

Sourabh Radhakrishnan ◽

Sonu Lazar Cyriac

Keyword(s):

Cancer Patients ◽

Bacterial Infections ◽

Tertiary Care ◽

Gram Positive ◽

Cross Sectional ◽

Gram Negative ◽

Mortality And Morbidity ◽

E Coli ◽

Resistance To Penicillin ◽

Study Laboratory

Background: Opportunistic bacterial infections remain a serious morbidity among cancer patients. This study was aimed to determine the bacteriological and antibiotic profile of cancer patients admitted to the ICU of a tertiary care centre.Methods: Cross sectional study was done among cancer patients admitted in the Oncology neutropenic ICU during the period from August 2017 to July 2019. All patients admitted with a proven diagnosis of cancer for whom at least one bacterial culture was sent from any site were included in the study. Laboratory on culture reports were obtained from patient files and analysed.Results: A total of 278 samples from 256 patients (60±11.6 years) were analysed. Among the 111/278 positive cultures, 29 were blood samples and 1 was a pleural fluid sample. Gram negative organisms were 62.1% with Escherichia coli (25, 36.2%) as prevalent. Among the 37.8% gram positives, Staphylococcus aureus (18. 42.8%) was prevalent. Most of the E. coli strains showed highest resistance to ceftazidime (96%) and highest sensitivity to amikacin. The commonest gram-positive organism, Staphylococcus species were 100 % sensitive to vancomycin and linezolid and 100 % resistance to penicillin. Conclusions: E. coli (gram negative) showed highest resistance to ceftazidime and sensitivity to amikacin. S. aureus (gram positive) was sensitive to vancomycin and linezolid and resistance to penicillin. An antibiogram for cancer patients helps the clinician to initiate an appropriate empirical antibiotic therapy to reduce mortality and morbidity.

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Serum biomarkers to differentiate Gram-negative, Gram-positive and fungal infection in febrile patients

Journal of Medical Microbiology ◽

10.1099/jmm.0.001360 ◽

2021 ◽

Vol 70 (7) ◽

Author(s):

Dongguang Niu ◽

Qian Huang ◽

Fan Yang ◽

Weiliang Tian ◽

Chen Li ◽

...

Keyword(s):

Bloodstream Infection ◽

Bacterial Infections ◽

Fungal Infections ◽

Serum Levels ◽

Serum Biomarker ◽

Diagnostic Efficiency ◽

Gram Positive ◽

Gram Negative ◽

Neutrophil Lymphocyte Ratio ◽

Bacteria And Fungi

Introduction. Contamination of specimens and overuse of broad spectrum antibiotics contribute to false positives and false negatives, respectively. Therefore, useful and applicable biomarkers of bacteremia are still required. Hypothesis/Gap Statement. IL-6 can be used as a serum biomarker to discriminate among bacterial infections and fungal infections in febrile patients with a bloodstream infection. Aim. We aimed to evaluate the diagnostic efficiency of neutrophil/lymphocyte ratio (NLR), procalcitonin (PCT) and interleukin-6 (IL-6) in discriminating Gram-negative (G−) bacteria from Gram-positive (G+) bacteria and fungi in febrile patients. Methodology. A total of 567 patients with fever were evaluated. Serum levels of IL-6, PCT, NLR and CRP were compared among a G− group (n=188), a G+ group (n=168), a fungal group (n=38) and a culture negative group (n=173). Sensitivity, specificity, Yuden’s index and area under the Receiver operating characteristic (ROC) curve (AUC) were obtained to analyse the diagnostic abilities of these biomarkers in discriminating bloodstream infection caused by different pathogens. Results. Serum IL-6 and PCT in the G− group increased significantly when compared with both the G+ group and fungal group (P <0.05). AUC of IL-6 (0.767, 95 % CI:0.725–0.805) is higher than AUC of PCT (0.751, 95 % CI:0.708–0.796) in discriminating the G− group from G+ group. When discriminating the G− group from fungal group, the AUC of IL-6 (0.695, 95 % CI:0.651–0.747) with a cut-off value of 464.3 pg ml−1 was also higher than the AUC of PCT (0.630, 95 % CI:0.585–0.688) with a cut-off value of 0.68 ng ml−1. Additionally, AUC of NLR (0.685, 95 % CI:0.646–0.727) in discriminating the fungal group from G+ group at the cut-off value of 9.03, was higher than AUC of IL-6, PCT and CRP. Conclusion. This study suggests that IL-6 could be used as a serum biomarker to discriminate among bacterial infections and fungal infections in febrile patients with a bloodstream infection. In addition, NLR is valuable to discriminate fungal infections from Gram-positive infections in febrile patients with a bloodstream infection.

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Non fermentative gram negative bacilli as nosocomial pathogens: Identification and antibiotic sensitivity in clinical samples of indoor patients

Nepal Journal of Medical Sciences ◽

10.3126/njms.v3i2.13452 ◽

2015 ◽

Vol 3 (2) ◽

pp. 101-105 ◽

Cited By ~ 1

Author(s):

D Sharma ◽

N Vyas ◽

P Sinha ◽

A Mathur

Keyword(s):

Burkholderia Cepacia ◽

Treatment Options ◽

Antibiotic Sensitivity ◽

Burkholderia Cepacia Complex ◽

Clinical Samples ◽

Sensitivity Testing ◽

Gram Negative ◽

Nosocomial Pathogens ◽

Sensitivity Pattern ◽

Medical Icus

Background: Non fermenting gram negative bacilli (NFGNB) are usually considered to be non pathogenic commensals of little significance, however, data suggest that they are remarkable because of antimicrobial resistance; propensity to cause outbreaks and complex epidemiology. This study was conducted to find out the prevalence and sensitivity pattern of NFGNB from various clinical samples.Methods: A total of 519 samples were received from patients suspected of having hospital acquired infections (HAI), admitted in Sawai Man Singh Hospital, Jaipur, India. Organisms grown on culture were subjected to phenotypic identification along with antimicrobial sensitivity testing by Kirby Bauer’s disc diffusion method.Results: Among 366 culture positive samples, 94 (25.6%) NFGNB were isolated. Maximum pevalence prevalence was found in burn ward i.e. 76.7 % followed by surgical wards 71.0%, surgical ICUs 69.6% and medical ICUs 68.0 %. Highest yield was found in pus/wound samples (95.5%) while it was only 23.7% in blood samples. Pseudomonas aeruginosa was the most common isolate (48.9%), followed by Acinetobacter baumannii (33%), Stenotrophomonas maltophilia (13.8%) and Burkholderia cepacia complex (4.3%). P.aeruginosa and A. baumanii strains were most sensitive to Meropenem. S.maltophilia showed maximum sensitivity with ticarcillin/ clavulanic acid and B. cepacia complex with Piperacillin/ Tazobactam.Conclusion: Isolation of NFGNB and their antibiotic susceptibility pattern should be regarded with all seriousness in clinical practice and epidemiology because they are emerging nosocomial pathogens and by being resistant to multiple antibiotics, their prevalence not only limits the treatment options but also act as a reservoir of drug resistance genes.Nepal Journal of Medical Sciences Vol.3(2) 2014: 101-105

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