scholarly journals 226. Multidrug Resistant Polymicrobial Gram-negative Bacteremia in Hematologic Cancer Patients with Febrile Neutropenia at the Uganda Cancer Institute

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S220-S221
Author(s):  
Margaret Lubwama ◽  
Freddie Bwanga ◽  
David Kateete ◽  
Scott Adams ◽  
Betty Namubiru ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Cox Regression ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Gram Positive ◽  
Gram Negative ◽  
Hematologic Cancer ◽  
Polymicrobial Infections

Abstract Background Bloodstream infections (BSI) are associated with significant mortality in hematologic cancer patients with febrile neutropenia. Poor clinical outcomes are associated with presence of multidrug resistant (MDR) organisms and polymicrobial infections. We sought to determine antimicrobial resistance and outcomes of polymicrobial bloodstream infections in hematologic cancer patients with febrile neutropenic episodes (FNEs) at the Uganda Cancer Institute. Methods Blood drawn from participants during an FNE (fever ≥ 37.5°C and neutrophil count ≤ 1000 cells/µL) was cultured in the BACTEC 9120 blood culture system. Bacteria from positive cultures were identified biochemically. Antimicrobial susceptibility testing was performed with the disc diffusion method. Participants were followed for 30 days from first FNE onset for death from any cause. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95%). Results Six hundred and twenty-nine participants were followed for FNE. Two hundred and twenty-eight FNEs in 159 participants were observed. Of 181 FNEs with blood cultures completed, 65 (36%) had pathogenic organism isolated. A total of 74 Gram negative and 18 Gram positive bacteria were isolated. Forty-eight (74%) FNEs had monomicrobial (MBSI) and 17 (26%) had polymicrobial (PBSI) bloodstream infections. Gram negative - Gram negative (10 out of 17, 59%) was the most frequent PBSI combination (Fig 1). Up to 75% (12 out of 16) of Gram-negative PBSI were MDR. The most common organism isolated was E. coli (38% of isolates). Participants with PBSI had higher early mortality rates at 7 days compared to MBSI and negative cultures (44%, 22%, and 16% for PBSI, MBSI, and negative respectively; HR (95% CI): 3.63 (1.49, 8.86) for PBSI v. negative/MBSI cultures). Similarly, PBSI was associated with higher mortality within 30 days of FNE onset (63%, 52%, and 38% for PBSI, MBSI, and negative respectively; HR (95% CI): 2.17 (1.09, 4.32) for PBSI v. negative/MBSI) (Fig 2). Figure 1. Bar graph showing combinations for polymicrobial bloodstream infections (PBSI). GNGN: Gram-negative – Gram-negative; GNGP: Gram-negative – Gram-positive; GNO: Gram-negative – Other (fungi); GPGP: Gram-positive – Gram-positive Figure 2. Kaplan-Meier failure curves of participants with negative cultures, monomicrobial infections and polymicrobial infections Conclusion PBSI episodes were more likely to be multidrug resistant and are associated with higher mortality. Empirical therapy for patients with PBSI should consider multidrug resistant Gram-negative bacteria Disclosures All Authors: No reported disclosures

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

2015 ◽  
Vol 7 ◽  
pp. e2015044 ◽  
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.

scholarly journals Trends of Bloodstream Infections in a University Greek Hospital during a Three-Year Period: Incidence of Multidrug-Resistant Bacteria and Seasonality in Gram-negative Predominance

2017 ◽  
Vol 66 (2) ◽  
pp. 171-180 ◽  
Author(s):  
Fevronia Kolonitsiou ◽  
Matthaios Papadimitriou-Olivgeris ◽  
Anastasia Spiliopoulou ◽  
Vasiliki Stamouli ◽  
Vasileios Papakostas ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Carbapenem Resistant

The aim of the study was to assess the epidemiology, the incidence of multidrug-resistant bacteria and bloodstream infections’ (BSIs) seasonality in a university hospital. This retrospective study was carried out in the University General Hospital of Patras, Greece, during 2011–13 y. Blood cultures from patients with clinical presentation suggestive of bloodstream infection were performed by the BacT/ALERT System. Isolates were identified by Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the disk diffusion method and E-test. Resistance genes (mecA in staphylococci; vanA/vanB/vanC in enterococci; blaKPC/blaVIM/blaNDM in Klebsiella spp.) were detected by PCR. In total, 4607 (9.7%) blood cultures were positive from 47451 sets sent to Department of Microbiology, representing 1732 BSIs. Gram-negative bacteria (52.3%) were the most commonly isolated, followed by Gram-positive (39.5%), fungi (6.6%) and anaerobes bacteria (1.8%). The highest contamination rate was observed among Gram-positive bacteria (42.3%). Among 330 CNS and 150 Staphylococcus aureus, 281 (85.2%) and 60 (40.0%) were mecA-positive, respectively. From 113 enterococci, eight were vanA, two vanB and two vanC-positives. Of the total 207 carbapenem-resistant Klebsiella pneumoniae (73.4%), 202 carried blaKPC, four blaKPC and blaVIM and one blaVIM. A significant increase in monthly BSIs’ incidence was shown (R2: 0.449), which may be attributed to a rise of Gram-positive BSIs (R2: 0.337). Gram-positive BSIs were less frequent in spring (P < 0.001), summer (P < 0.001), and autumn (P < 0.001), as compared to winter months, while Gram-negative bacteria (P < 0.001) and fungi (P < 0.001) were more frequent in summer months. BSIs due to methicillin resistant S. aureus and carbapenem-resistant Gram-negative bacteria increased during the study period. The increasing incidence of BSIs can be attributed to an increase of Gram-positive BSI incidence, even though Gram-negative bacteria remained the predominant ones. Seasonality may play a role in the predominance of Gram-negative’s BSI.

scholarly journals 169. Multidrug-Resistant Bacteria Are Common Cause of Neutropenic Fever and Increase Mortality Among Patients with Hematologic Malignancies in Uganda

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S108-S109
Author(s):  
Margaret Lubwama ◽  
Scott Adams ◽  
Catherine Muwonge ◽  
Freddie Bwanga ◽  
David Kateete ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Multidrug Resistant ◽  
Lymphocytic Leukemia ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Negative ◽  
Hematologic Cancer

Abstract Background Cancer patients are at risk of developing severe infections. Empiric management of infections is complicated by emerging antimicrobial resistance and changing local epidemiology of organisms. We sought to determine predominant species causing bacteremia, their antimicrobial resistance profiles, and their contribution to mortality among hematologic cancer patients with febrile neutropenia at the Uganda Cancer Institute. Methods Blood drawn from participants during a febrile neutropenic episode (FNE; fever ≥37.5°C and neutrophil count ≤1,000 cells/µL) was cultured in the BACTEC 9120 blood culture system. Bacteria from positive cultures were identified biochemically. Antimicrobial susceptibility testing was performed with the disc diffusion method. Logistic regression and proportional hazards regression were applied to estimate associations between participant characteristics and FNE, bacteremia, and mortality. Results Of 246 participants, 74 (30%) had an FNE. During the first FNE, 6/21 (29%) participants with acute lymphocytic leukemia (ALL) developed bacteremia compared with 16/31 (52%) with acute myeloid leukemia (AML) (OR 2.22 (0.65, 7.4)). AML patients were specifically at higher risk of Gram-negative bacteremia (OR 4.59 (1.09, 19.3). Of the 41 aerobic bacteria isolated, 32 (78%) were Gram-negative, the most common being Klebsiella pneumoniae (11; 34%). Seventeen (53%) of the Gram-negative bacteria displayed the extended spectrum β lactamase phenotype and 5 (16%) were resistant to carbapenems. One of the eight Enterococcus species was vancomycin resistant. Overall survival among patients with FNE was 54% at 30 days and 19% at 100 days. Bacteremia was associated with higher mortality within 30 days (HR 2.1 (0.99, 4.45)) and 100 days (31% vs.10%; HR 2.23 (1.09, 4.59)). Conclusion Multidrug-resistant bacteria are the main cause of bacteremia and increase mortality in febrile neutropenic hematologic cancer patients at the UCI. Enhanced microbial surveillance, infection control and antimicrobial stewardship programs are needed to guide therapy and address emerging antimicrobial resistance at our institution. Disclosures All authors: No reported disclosures.

scholarly journals Cyathea gigantea (Cyatheaceae) as an antimicrobial agent against multidrug resistant organisms

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kathakali Nath ◽  
Anupam Das Talukdar ◽  
Mrinal Kanti Bhattacharya ◽  
Deepshikha Bhowmik ◽  
Shiela Chetri ◽  
...  
Keyword(s):  
Antibacterial Activity ◽  
Antibacterial Property ◽  
Treatment Options ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Synergistic Activity ◽  
Gram Positive ◽  
Traditional Use ◽  
Gram Negative ◽  
Multidrug Resistant Organisms

Abstract Background Rapid emergence of multidrug resistant (MDR) organisms in hospital and community settings often result into treatment failure, thus leading the clinicians with fewer treatment options. Cyathea gigantea, an ethnomedicinally important fern used in cuts and wound infections. So, if this medicinal plant is used in treating the MDR infections then it might bring certain relief in future treatment options. Methods Antibacterial activity of C. gigantea against MDR bacteria was assed using well diffusion and broth microdilution methods to determine the diameters of growth inhibition zones, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Synergistic activity was also determined with the conventional antibiotics by disc diffusion method followed by FIC index of each of the tested antibiotic was calculated. The active extract was then subjected to fractionation by column chromatography and antibacterial activity was done with each of the collected fractions. Results Crude extract of C. gigantea was found to be active against all the tested organisms. The MIC was 200 μg/ml against Gram-positive i.e., Staphylococcus aureus ATCC 25923 and 400 μg/ml against Gram-negative i.e., Escherichia coli ATCC 25922 and Pseudomonas aeruginosa PAO1, while the MBC was 400 μg/ml in case of Gram-positive and 800 μg/ml for Gram-negative. The synergistic activity revealed that the plant extract increased the antibacterial property of the studied antibiotics and the FIC index showed that significant synergistic activity was shown by ciprofloxacin followed by tetracycline, ampicillin and oxacillin. Antibacterial activity with the fractionated extract showed that the FR II, FR III and FR IV were active against both Gram-positive and Gram-negative bacteria, whereas FR I, FR V and FR VI did not show antibacterial property against any of the tested bacteria. Conclusions Extracts of C. gigantea was found active against both selected Gram-positive and Gram-negative organisms and thus offers the scientific basis for the traditional use of the fern. The present study also provides the basis for future study to validate the possible use against multidrug resistant organisms.

scholarly journals Study of Aerobic Bacterial Etiology and Their Antibiogram from Pus Samples in a Tertiary Care Hospital

2021 ◽  
Vol 8 (4) ◽  
pp. 358-362
Author(s):  
T. Kanakadurgamba ◽  
Rama Lakshmi Koripella ◽  
B. Gowtham
Keyword(s):  
Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Klebsiella Pneumonia ◽  
Microbiological Analysis ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Positive ◽  
Gram Positive Cocci

Introduction: The spread of multidrug resistant bacteria has added a new angel to the problem of wound infections which are a major cause of morbidity. To avoid difficulty in treatment of such infections it is mandatory for every pus sample to undergo Culture and sensitivity. Aim: To isolate and study the antibiogram of the aerobic bacteria from pus samples. Materials and Methods: A total of 426 pus samples received from various wards in the Microbiology department. Andhra Medical College, Visakhapatnam were processed as per standard guidelines in the laboratory. All the aerobic bacterial isolates obtained were kept for antibiogram by Kirby Bauer’s disc diffusion method as per CLSI Guidelines. Results: Out of 426 samples 394 (92.4%) were culture positive. Among culture positive samples 90.6% were pure cultures and 9.4% were mixed isolates. Gram negative bacilli were 72.8% of the total isolates and 27.2% were Gram positive cocci. Escherichia coli and Klebsiella pneumonia were the predominant isolates (30.3% and 28.9%) followed by Pseudomonas aeruginosa (24%), Proteus species (9.7%) and Acinetobacter species (6.9%). Among Gram positive cocci Staphylococcus aureus (62.6%), Enterococci (20.5%) and Coagulase Negative Staphylococcus (11.2%) and Streptococci (3.7%). GNB were more sensitive to Colistin (92%), Amikacin (86%), Imipenem and Meropenem (86% and 84.4%), Piperacillin Tazobactam (84%), Gentamycin (78%), Cefaperazone Sulbactam (76.2%) and Ciprofloxacin (56%). Gram positive cocci were sensitive to Linezolid and Teicoplanin (98% each), Vancomycin (96.2%), Clindamycin (84%), Gentamycin (79%), Azithromycin (76.4%), Ciprofloxacin (66%) and Amoxiclav (54%) out of 62.6% Staphylococcus aureus isolates 31.4% were MRSA and out of 72.8% of Gram negative bacilli 38.2% were ESBLS. Conclusion: As multidrug resistant bacterial strains are emerging in various infectious and pyogenic wound infection is most important cause of morbidity, it is important for a clinician to send all pus samples for microbiological analysis and their antibiogram before putting cases on antibiotics. Keywords: Pus samples, Multidrug resistance, Gram negative bacilli, Gram positive cocci, Antimicrobial sensitivity.

In-vitro Antioxidant and Antibacterial Activity of Methanolic Extract of Shorea robusta Gaertn. F. Resin

2016 ◽  
Vol 6 (4) ◽  
pp. 68
Author(s):  
Sushma Vashisht ◽  
Manish Pal Singh ◽  
Viney Chawla
Keyword(s):  
Antibacterial Activity ◽  
Methanolic Extract ◽  
Diffusion Method ◽  
Gram Negative Bacteria ◽  
Disc Diffusion ◽  
Gram Positive ◽  
Gram Negative ◽  
Shorea Robusta ◽  
Dose Dependent ◽  
Resin Extract

The methanolic extract of the resin of Shorea robusta was subjected to investigate its antioxidant and antibacterial properties its utility in free radical mediated diseases including diabetic, cardiovascular, cancer etc. The methanol extract of the resin was tested for antioxidant activity using scavenging activity of DPPH (1,1-diphenyl-2-picrylhydrazil) radical method, reducing power by FeCl3 and antibacterial activity against gram positive and gram negative bacteria using disc diffusion method. The phytochemical screening considered the presence of triterpenoids, tannins and flavoniods. Overall, the plant extract is a source of natural antioxidants which might be helpful in preventing the progress of various oxidative stress mediated diseases including aging. The half inhibition concentration (IC50) of resin extract of Shorea robusta and ascorbic acid were 35.60 µg/ml and 31.91 µg/ml respectively. The resin extract exhibit a significant dose dependent inhibition of DPPH activity. Antibacterial activity was observed against gram positive and gram negative bacteria in dose dependent manner.Key Words: Shorea robusta, antioxidant, antibacterial, Disc-diffusion, DPPH.

Antibacterial activity of magnesium oxide nanoparticles prepared by Calcination method

2019 ◽  
Vol 10 (03) ◽  
Author(s):  
Elaf Ayad Kadhem ◽  
Miaad Hamzah Zghair ◽  
Sarah , Hussam H. Tizkam, Shoeb Alahmad Salih Mahdi ◽  
Hussam H. Tizkam ◽  
Shoeb Alahmad
Keyword(s):  
Antibacterial Activity ◽  
Magnesium Oxide ◽  
Diffusion Method ◽  
Oxide Nanoparticles ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Magnesium Oxide Nanoparticles ◽  
Agar Disc

magnesium oxide nanoparticles (MgO NPs) were prepared by simple wet chemical method using different calcination temperatures. The prepared NPs were characterized by Electrostatic Discharge (ESD), Scanning Electron Microscope (SEM) and X-ray Diffraction (XRD). It demonstrates sharp intensive peak with the increase of crystallinty and increase of the size with varying morphologies with respect to increase of calcination temperature. Antibacterial studies were done on gram negative bacteria (E.coli) and gram positive bacteria (S.aureus) by agar disc diffusion method. The zones of inhibitions were found larger for gram positive bacteria than gram negative bacteria, this mean, antibacterial MgO NPs activity more active on gram positive bacteria than gram negative bacteria because of the structural differences. It was found that antibacterial activity of MgO NPs was found it has directly proportional with their concentration.

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

2020 ◽  
Vol 70 (12) ◽  
pp. 4287-4294
Keyword(s):  
Antibiotic Resistance ◽  
Cancer Patients ◽  
Bacterial Pathogen ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Antibiotic Resistance Profile ◽  
Oncological Patients ◽  
Eastern European Countries ◽  
Klebsiella Spp

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

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