scholarly journals Bloodstream infections in patients with hematologic malignancies and febrile neutropenia - a single center experience

2021 ◽  
Vol 74 (3-4) ◽  
pp. 83-89
Author(s):  
Marina Dragicevic-Jojkic ◽  
Ivana Urosevic ◽  
Amir El Farra ◽  
Borivoj Sekulic ◽  
Ivanka Percic ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Fatal Outcome ◽  
Antibiotic Sensitivity ◽  
Bloodstream Infections ◽  
Hematologic Malignancies ◽  
High Rate ◽  
Antibiotics Resistance ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Acinetobacter Spp

Introduction. Bacterial blood infections during febrile neutropenia episodes are urgent medical conditions which were and still are the main cause of morbidity and mortality among patients with hematologic malignancies. The aim of this study was to determine the incidence and clinical characteristics of bacteremia, infectious agents, presence and incidence of antibiotic resistance, as well as the treatment outcome of bloodstream infections in patients with hematologic malignancies. Material and Methods. A three-year retrospective study included 107 patients with hematologic malignancies and positive blood culture results during febrile neutropenia. Results. The most common isolates were Gram-negative bacteria (58.5%), with Escherichia coli being the most frequent pathogen. The Gram-negative microorganisms were mostly sensitive to carbapenems in 70.7%, whereas sensitivity to other antibiotics was as follows: piperacillin/ tazobactam 62%, amikacin 58.5%, and third-generation cephalosporins 50.5%. Acinetobacter spp. was sensitive only to colistin (94.1%). The antibiotic sensitivity among Gram-positive bacteria was highest to linezolid (97.1%), followed by teicoplanin (81.4%) and vancomycin (81.4%). In our patients, the mortality rate during the first 28 days from the moment of positive isolates was high (37.4%). Most patients died within the first seven days. Bacterial blood infections caused by Gram-negative bacteria were associated with significantly higher mortality (?2 = 4.92, p = 0.026). Acinetobacter spp. was isolated in almost half of the patients with fatal outcome, of whom 62.5% died in the first 24 hours. Conclusion. Bacterial bloodstream infections are severe complications with a high rate of mortality in febrile neutropenic hematological patients. Gram-negative bacteria were the most common isolates in our Clinic, with high mortality. It is of utmost importance to constantly monitor the resistance of bacteria to antibiotics, as well as to prevent and control the spread of resistant strains. Antibiotics resistance patterns should regularly be followed.

scholarly journals Microbiological profiles and prognostic factors of infection mortality in febrile neutropenic children with malignancy

2021 ◽  
Vol 61 (5) ◽  
pp. 283-90
Author(s):  
Yuni Astria ◽  
Hindra Irawan Satari ◽  
Hartono Gunardi ◽  
Hikari Ambara Sjakti
Keyword(s):  
Prognostic Factors ◽  
Febrile Neutropenia ◽  
Antibiotic Sensitivity ◽  
Hematologic Malignancies ◽  
High Morbidity ◽  
Venous Cannulation ◽  
Central Venous Cannulation ◽  
Central Venous ◽  
Gram Negative ◽  
Candida Sp

    Background Post-chemotherapy febrile neutropenia results in high morbidity and mortality in children with malignancy. Many prognostic factors, such as microorganism patterns, as well as the use of antibiotics and antifungals can affect the outcomes. However, limited study is available in Indonesia. Objective To determine the microbial profiles, antibiotic sensitivity, and other factors that influence mortality from febrile neutropenia in pediatric malignancies with infections. Methods This retrospective cohort and descriptive study of 180 children with 252 episodes of neutropenic fever was done in Cipto Mangunkusumo Hospital, Jakarta, between 2015 and 2017. Medical history of possible predictive prognostic factors, including microorganism patterns and antibiotic sensitivity, were recorded. Prognostic factors were analyzed using multivariate logistic regression tests. Results The most common bacteria was Gram-negative (54.5%), while  Candida sp. was the most common fungal infection (82.5%). Klebsiella sp. was mainly sensitive to amikacin (85.71%), while Pseudomonas aeruginosa was sensitive to ceftazidime (75%), as well as amikacin and gentamicin (100% sensitivity in combination). Staphylococcus sp. was mainly sensitive to amoxi-clav and ampi-sulbactam (76.9%). Almost all fungal groups were susceptible to fluconazole, ketoconazole, voriconazole (80-100%). Prognostic factors that increased mortality risk were central venous cannulation (RR 1.947; 95%CI 1.114 to 3.402), wasting (RR 1.176; 95%CI 1.044 to 1.325), severe wasting (RR 1.241; 95%CI 0.975 to 1.579), and hematologic malignancies (RR 0.87; 95%CI 0.788 to 0.976). Conclusion Central venous cannulation and wasting are significant prognostic factors of increased mortality in children with febrile neutropenia. Gram negative bacteria along with Candida sp. is the most common pathogen in such condition.  

#43: Monotherapy Experience in Pediatric Patients with High-risk Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S19-S19
Author(s):  
Valentina Gutiérrez ◽  
Ximena Claverie
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Fungal Infections ◽  
Clinical Signs ◽  
Empiric Therapy ◽  
Fourth Generation ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Third Line ◽  
Clinical Worsening

Abstract Background Fever during neutropenia is a common occurrence in children with cancer. In a systematic review of RCTs of pediatric febrile neutropenia, compared monotherapy with aminoglycoside-containing combination therapy found no significant differences in failure rates, infection-related mortality, or overall mortality. The updated pediatric-specific guidelines recommend initiation of empirical antibiotic monotherapy using an antipseudomonal β-lactam, a fourth-generation cephalosporin, or a carbapenem for pediatric high-risk febrile neutropenia. However, local epidemiology and resistance patterns should be evaluated regularly. Our local hospital epidemiology does not have Pseudomonas aeruginosa isolates, therefore, we used ceftriaxone as monotherapy in patients with high-risk febrile neutropenia without other risk factors. The goal of our investigation is to describe the experience of using third-generation cephalosporins in these patients. Methods Descriptive study of high-risk febrile neutropenia episodes in patients admitted to the Pediatric Oncology Unit of Hospital Dr. Sótero del Río, Santiago, Chile. We included patients ≤15 years from June 2016 until November 2019. Results We found a total of 133 high-risk febrile neutropenia episodes corresponding to 50 patients, 78% were leukemia and 22% were solid tumor patients. Of the 133 episodes, 92 (69%) had clinical signs at admission, mostly respiratory in 46 (50%) of the cases, 18 (29%) had mucositis and 13 (14%) had diarrhea. Of 133 episodes, 41 (31%) did not have any source at clinical examination. Eighty-six (65%) cases started ceftriaxone at admission, 28 (33%) maintained ceftriaxone for 7 days of treatment with good clinical response. Of this group 58 (67%) patients changed treatment: 32 (37%) cases started second-line antibiotics for clinical worsening, 19 (22%) cases required second- and third-line antibiotics for persistent fever and clinical worsening, and 7 (8%) received third-line antibiotics from the start for past microbiological history. Sixteen (12%) cases of total evolved with sepsis requiring intensive care unit management. We had 30 (23%) episodes with positive blood culture, 11 (37%) due to gram-positive bacteria, 16 (53%) gram-negative bacteria, and 3 (10%) cases of fungal infections. Of the gram-negative bacteria, 7 (44%) were ESBL producers, without P. aeruginosa isolates. One case died (0.7%) for refractory sepsis due to gram-negative bacteria. Conclusion Although we did not have P. aeruginosa isolates, due to the spread of ESBL strains, monotherapy with ceftriaxone is not a good option as initial therapy for high-risk febrile neutropenia patients. The empiric therapy has to be evaluated regularly and should always be based on local epidemiology.

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 Removal efficiency of Gram-positive and Gram-negative bacteria using a natural coagulant during coagulation, flocculation, and sedimentation processes

2019 ◽  
Vol 80 (9) ◽  
pp. 1787-1795 ◽  
Author(s):  
Shazwana Sha'arani ◽  
Siti Noor Fitriah Azizan ◽  
Fazrena Nadia Md Akhir ◽  
Muhamad Ali Muhammad Yuzir ◽  
Nor'azizi Othman ◽  
...  
Keyword(s):  
Removal Efficiency ◽  
Food Poisoning ◽  
Bloodstream Infections ◽  
Gram Negative Bacteria ◽  
Membrane Composition ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Jar Test ◽  
Sedimentation Processes

Abstract Staphylococcus sp. as Gram-positive and Escherichia coli as Gram-negative are bacterial pathogens and can cause primary bloodstream infections and food poisoning. Coagulation, flocculation, and sedimentation processes could be a reliable treatment for bacterial removal because suspended, colloidal, and soluble particles can be removed. Chemical coagulants, such as alum, are commonly used. However, these chemical coagulants are not environmentally friendly. This present study evaluated the effectiveness of coagulation, flocculation, and sedimentation processes for removing Staphylococcus sp. and E. coli using diatomite with standard jar test equipment at different pH values. Staphylococcus sp. demonstrated 85.61% and 77.23% significant removal in diatomite and alum, respectively, at pH 5. At pH 7, the removal efficiency decreased to 79.41% and 64.13% for Staphylococcus sp. and E. coli, respectively. At pH 9, there was a decrease in Staphylococcus sp. after adding diatomite or alum compared with that of E. coli. The different removal efficiencies of the Gram-positive and Gram-negative bacteria could be owing to the membrane composition and different structures in the bacteria. This study indicates that diatomite has higher efficiency in removing bacteria at pH 5 and can be considered as a potential coagulant to replace alum for removing bacteria by the coagulation process.

scholarly journals ISOLATION AND IDENTIFICATION OF MICROFLORA FROM APPARENTLY HEALTHY CAGED PARROTS OF DHAKA ZOO OF BANGLADESH

1970 ◽  
Vol 8 (1) ◽  
pp. 05-10 ◽  
Author(s):  
J Akhter ◽  
MT Hossain ◽  
MT Islam ◽  
MP Siddique ◽  
MA Islam
Keyword(s):  
Research Work ◽  
Antibiotic Sensitivity ◽  
Biochemical Properties ◽  
Gram Negative Bacteria ◽  
Bacterial Isolates ◽  
Salmonella Spp ◽  
Isolation And Identification ◽  
Gram Negative ◽  
E Coli ◽  
Apparently Healthy

The research work was conducted to isolate and identify the microflora from apparently healthy caged parrots. A total of 45 samples (oral swabs, cloacal swabs and feces) were collected from five types of caged parrots (Gray cockatiels, Rose ringed parakeet, Alexandriane parakeet, Red breast parakeet and Blossom headed parakeet) of Dhaka Zoo during the period from April to August 2009. The samples were cultured on different bacteriological media and the bacteria were identified by their cultural and biochemical properties. All the isolates were allowed for antibiogram study. The bacteria isolated in this study from different types of caged parrots were E. coli (64.44%), Salmonella spp. (46.67%), Staphylococcus spp. (46.67%), Pasteurella spp. (33.33%), Proteus spp. (6.67%) and some unidentified Gram-positive and Gram-negative bacteria. Of these isolates, E. coli was the most frequent isolate. The frequency of Gram-negative bacteria was higher in this study. The percentage of bacterial isolates recovered from each type of parrots was almost similar. Irrespective of types of parrots, the higher percentage of different bacteria was isolated from cloacal swab (77.78%) followed by feces (75.56%). The 68.89% isolates were recovered from oral swab. All the suspected isolates of Salmonella spp. were confirmed by slide agglutination test using Salmonella polyvalent ‘O’ antiserum. Among the 21 Salmonella spp. isolated in this study, 4 (19.05%) isolates were identified as S. Pullorum when tested with specific antisera against S. Pullorum. The results of antibiotic sensitivity tests revealed that ampicillin and amoxicillin were completely resistant to E. coli and Pasteurella spp.; ampicillin to Proteus spp.; and furazolidone to Salmonella spp. and Pasteurella spp. However, the antibiotics of fluoroquinolone group such as ciprofloxacin, norfloxacin and enrofloxacin showed moderate to high sensitivity against almost all the bacterial isolates. Of these, ciprofloxacin was found to be consistently highly sensitive to all the bacterial isolates. DOI = 10.3329/bjvm.v8i1.8349 Bangl. J. Vet. Med. (2010). 8(1): 05-10

Catheter-related bloodstream infections caused by Gram-negative bacteria

2013 ◽  
Vol 85 (4) ◽  
pp. 316-320 ◽  
Author(s):  
E. Bouza ◽  
A. Eworo ◽  
A. Fernández Cruz ◽  
E. Reigadas ◽  
M. Rodríguez-Créixems ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Gram Negative Bacteria ◽  
Gram Negative
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