Bacterial Spectrum and Antimicrobial Susceptibility Pattern of Bloodstream Infections in Children with Febrile Neutropenia: Experience of Single Center in Southeast of Turkey

Abstract

Empirical antimicrobial therapy is usually started in febrile neutropenic patients without having culture results. The aim of this study was to help determine the policies of empirical antibiotic usage in febrile neutropenic children by detecting the antimicrobial susceptibility profile in this group of patients. In this study 811 blood cultures taken from neutropenic children hospitalized at the Department of Oncology of Gaziantep Children Hospital November 2007 and February 2010 were retrospectively evaluated. Blood cultures were routinely collected in aerobic and anaerobic media and incubated using the BACTEC system. Identification and antimicrobial susceptibility testing of the isolates to antimicrobial agents was performed using the Vitek2 Ò system according to the recommendations of the Clinical and Laboratory Standards Institute. Of 811 isolates analyzed, 128 (56.4%) were gram positive cocci, 43 (18.9%) were gram negative bacilli and fungi accounted for 56 (24.7%). The main isolated Gram-positive bacteria from blood were coagulase-negative staphylococcus (56.7%), followed by methicillin-resistant Staphylococcus aureus (14.1%). S. aureus and Streptococcus spp. were all susceptible to linezolid, vancomycin and teicoplanin. S aureus was still susceptible to few other antimicrobial agents such as tetracycline (82.4%), chloramphenicol (55.6%). Seven E. faecium, 7 E. fecalis and 1 E. hirae was isolated from blood cultures. Vancomycin resistance was detected in 6 out of 15 (40%) Enterococcus spp. isolates. Among gram-negative bacteria E. coli (30.2%) was followed by Klebsiella pneumoniae (20.9%) and Proteus spp. (18.6%). Imipenem (89.2%), meropenem (86.6%), chloramphenicol (88.9%), amicasin (82.4%) and fosfomycin (81.3%) showed highest susceptibility in vitro activity against all Gram-negative isolates. To know the antimicrobial susceptibility profile of the pathogens frequently isolated from febrile neutropenic children and to consider this profile before starting an empirical antibiotic therapy would help the clinics which have any role in the treatment of these patients to determine the empirical antibiotic usage policies.

Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer

“…Secondly, in 13 of the studies the bacterial isolates were collected during episodes of febrile neutropenia [7,8,10,11,13,14 & ,17,18,20,21,26,29]. Thirdly, the bacteria were isolated from different sources; 16 studies included BSIs only [7,8,[10][11][12]14 & , 15-18, 21,22,24,25 & ,27,29], and eight studies isolated the bacteria from clinical (and/or surveillance) samples for which the percentage of bloodstream isolates ranged from 42.9 to 74.8% in five studies [6,19,23,26,28] and was not reported in the remaining three [9,13,20]. Thirdly, the bacteria were isolated from different sources; 16 studies included BSIs only [7,8,[10][11][12]14 & , 15-18, 21,22,24,25 & ,27,29], and eight studies isolated the bacteria from clinical (and/or surveillance) samples for which the percentage of bloodstream isolates ranged from 42.9 to 74.8% in five studies [6,19,23,26,28] and was not reported in the remaining three [9,13,20].…”

“…Out of the remaining 11 studies, in five the rates of patients with neutropenia ranged from 39.4 to 62.2% [16,23,24,27,28]; in the other six studies, while neutropenic patients accounted for a large proportion of the patient population, the exact rate was not reported [6,9,15,19,22,25 & ]. Finally, the reported studies were conducted in different geographic areas: 11 studies in Asia [8,10,11,13,[15][16][17]19,22,26,29], nine in Western Europe [9,14 & ,18,20,21,24,25 & ,27,28], and four in the Middle East [6,7,12,23]. Finally, the reported studies were conducted in different geographic areas: 11 studies in Asia [8,10,11,13,[15][16][17]19,22,26,29], nine in Western Europe [9,14 & ,18,20,21,24,25 & ,27,28], and four in the Middle East [6,7,12,23].…”

“…Details of the in-vitro sensitivity profiles of E. coli isolates to the most common antimicrobial drugs were reported in 10 studies and are shown in Table 2 [7,8,10,11,13,15,18,19,22,31]. In general, more than 95% of the E. coli isolates were susceptible to carbapenems, with susceptibility rates ranging from 90.9 to 100% (means: 98.2% for imipenem and 96.4% for meropenem).…”

“…Data on the frequency of ESBL production have been described predominantly for E. coli and K. pneumoniae bloodstream isolates and vary between geographical areas. ESBL production among K. pneumoniae isolates causing BSIs in neutropenic patients has been reported with a frequency ranging from 3 to 66.6% (mean 37.8%) [7,10,11,15,22]. ESBL production among K. pneumoniae isolates causing BSIs in neutropenic patients has been reported with a frequency ranging from 3 to 66.6% (mean 37.8%) [7,10,11,15,22].…”

Efficacy and Safety of Linezolid in Treating Gram-Positive Bacterial Infection in the Elderly: A Retrospective Study

“…More importantly, community-acquired infections due to MRSA have become increasingly problematic in recent years [1,2]. Linezolid is an oxazolidinone antibiotic with good activity against drug resistant Gram-positive bacteria such as MRSA [3][4][5]. The mechanism of action of linezolid involves the inhibition of bacterial protein synthesis through binding to the domain V regions of the 23 S rRNA gene [6].…”