Bacteriological Profile and Antibiotic Sensitivity Pattern of Clinical Isolates in a Tertiary Cancer Care Center in the Northeast India

Talukdar, Anjan Kumar; Barman, Rashmisnata; Sarma, Anupam; Sharma, Jagannath Dev; Krishnatreya, Manigreeva; Hazarika, Munlima; Kataki, Amal Chandra

doi:10.1055/s-0040-1721176

Cited by 5 publications

(9 citation statements)

References 11 publications

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“…Ten out of the 13 (77%) positive blood cultures for bacteria during induction were due to gram-negative organisms. This is consistent with reports from other centres in India 14 15. Gram-positive infections are more common in Western countries, and they have a lower incidence of MDR infections than LMICs 9 10 12 13…”

Section: Discussionsupporting

confidence: 90%

“…Gram-negative septicaemia has higher mortality than gram-positive septicaemia and is more likely to be caused by multidrug resistant (MDR) bacteria 11–13. Therefore, a neutropenic diet is theoretically more likely to impact low-income and middle-income countries (LMICs) where gram-negative infections are more common, and colonisation rates with MDR gram-negative bacteria in the gut are high 14–17…”

Section: Introductionmentioning

confidence: 99%

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Neutropenic versus regular diet for acute leukaemia induction chemotherapy: randomised controlled trial

Radhakrishnan

Lagudu

Gangopadhyay

et al. 2022

BMJ Support Palliat Care

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ObjectivesRestriction of raw fruits and vegetables (neutropenic diet) is advised for patients receiving treatment for acute leukaemia in low-income and middle-income countries (LMICs) to reduce infections despite evidence to the contrary from high-income countries. We, therefore, conducted a randomised controlled trial to ascertain the efficacy of the neutropenic diet in an LMIC setting.MethodsPatients aged 1–60 years receiving induction chemotherapy for acute leukaemia were randomised to a regular or neutropenic diet. The study’s primary objective was to compare the incidence of major infections among patients receiving the two diets during induction chemotherapy. The secondary objectives were to compare stool microbial flora and induction mortality rates.ResultsWe randomised 200 patients, 98 patients to the regular diet arm and 102 to the neutropenic diet arm. Major infections occurred in 32 (32%) patients in the regular diet arm and 26 (25%) patients in the neutropenic diet arm (p=0.26). There were no statistically significant differences between patients receiving a regular diet versus neutropenic diet for blood culture positivity (n=6 vs 9), inotropic support (17 vs 12), mechanical ventilation (8 vs 5), third-line antibiotic use (28 vs 20), minor infections (12 vs 9), induction mortality (9 vs 4) and remission status (94% vs 94%). The stool culture on day 15 of induction grew multidrug-resistant bacteria in 38% of patients in the regular diet arm and 35% in the neutropenic diet arm (p=0.67).ConclusionsA neutropenic diet did not prevent infections, reduce mortality or change stool microbial flora in patients with acute leukaemia.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Neutropenic versus regular diet for acute leukaemia induction chemotherapy: randomised controlled trial

Radhakrishnan

Lagudu

Gangopadhyay

et al. 2022

BMJ Support Palliat Care

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“…Studies done by Talukdar et al 17 in 2023 among pediatric FN malignancy patients, showed only 7% A. baumannii which is far less than our study, another similar study by Babu KG et al 3 in 2016 showed 15.62% A. baumannii isolation.…”

Section: Discussioncontrasting

confidence: 64%

Microbiological profile and antimicrobial susceptibility patterns of blood stream infections in febrile neutropenic patients with hematological malignancies in a tertiary care hospital, Kolkata

Ganguly Bhattacharjee,

Mandal,

Mullick

et al. 2024

IJMMTD

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Blood stream infection (BSI) in febrile neutropenic (FN) patients with hematological malignancy is a common manifestation with high mortality rate. To reduce mortality knowledge of pathogens causing BSI and their antimicrobial susceptibility patterns are required for timely initiation of appropriate antimicrobial therapy. This study was aimed to characterize the pathogenic spectrum and antimicrobial resistance patterns of BSI in these patients. In this cross-sectional study patients admitted in the Hematology department over a period of one year with laboratory confirmed positive blood cultures were enrolled. Information regarding demographic profiles and microbiological profiles were recorded. Standard procedures were applied to identify the isolates and their resistance patterns in positive blood culture. Data was collected and analyzed on MS-Excel sheet with various charts and tables. During the study period of one year 198 episodes of BSI recorded in 147 FN patients. Majority of isolates were Gram-negative bacilli (GNB: n=107, 54.04%). Among GNB (n=34, 31.77%) was most frequently isolated and in Gram-positive cocci (GPC) majority isolated was (n=37, 62.71%). (n=12, 37.5%) was the commonest fungal pathogen isolated. Susceptibility to penicillin, clindamycin and quinolones were least among GPC. Among GNB higher resistance patterns were observed against ceftazidime, cefepime, cefoperazone-sulbactam, piperacillin-tazobactam and meropenem. All isolates were resistant to fluconazole. This study revealed a significant increase in proportion of Gram-negative non-fermenting bacteria (GNNFB). These findings highlight the necessity for regular revision of institutional antimicrobial policy which will reduce mortality as well as development of resistant pathogens.

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“…Similar findings were reported in other studies done on neutropenic patients harboring MDR organisms. 27 28 In our study, most of the MDR Gram-positive organisms were sensitive to vancomycin, whereas Garg et al noted that more than 50% of MDR Gram-positive organisms were vancomycin resistant. 29…”

Section: Discussionmentioning

confidence: 49%

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

Sampagar

Ritesh

Shiv

et al. 2021

Indian J Med Paediatr Oncol

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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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Bacteriological Profile and Antibiotic Sensitivity Pattern of Clinical Isolates in a Tertiary Cancer Care Center in the Northeast India

Cited by 5 publications

References 11 publications

Neutropenic versus regular diet for acute leukaemia induction chemotherapy: randomised controlled trial

Neutropenic versus regular diet for acute leukaemia induction chemotherapy: randomised controlled trial

Microbiological profile and antimicrobial susceptibility patterns of blood stream infections in febrile neutropenic patients with hematological malignancies in a tertiary care hospital, Kolkata

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

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