Febrile neutropenia in cancer patients in Kuwait: microbial spectrum and outcome

Al-Bahar, Soad; Pandita, Ramesh; Dhabhar, Boman; Al-Bahar, E.

doi:10.1007/bf00344056

Cited by 16 publications

(11 citation statements)

References 9 publications

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“…In our study of the etiology of bacterial infections in febrile neutropenic patients, gram-negative pathogens (65.94%) accounted for almost two-thirds of bacterial infections whereas gram-positive organisms were identified in 34.06%. Our findings are similar to other studies in our geographical region, pointing to the importance of covering gram-negative organisms empirically according to the most likely pathogens, and local sensitivity data in this high-risk group of patients [ 16 , 18 ].…”

Section: Discussionsupporting

confidence: 91%

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Bacterial Spectrum, Isolation Sites and Susceptibility Patterns of Pathogens in Adult Febrile Neutropenic Cancer Patients at a Specialist Hospital in Saudi Arabia

Sirkhazi

Sarriff

Aziz³

et al. 2014

World J Oncol

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BackgroundKnowing local spectrum and sensitivity for bacterial isolates causing febrile neutropenia is important as starting an appropriate empirical antibiotic therapy is considered a medical emergency in these high-risk patients.MethodsA retrospective study of a total of 106 microbiologically febrile episodes in hospitalized adult neutropenic cancer patients, who were admitted from May 2009 to May 2013, at King Fahad Specialist Hospital, Dammam, Saudi Arabia, was conducted.ResultsAmong 106 microbiologically documented febrile neutropenic episodes, the majority of malignancies were solid tumors accounting for 53.8% (57/106) and hematological malignancies accounted for 46.23% (49/106). The most common malignancies were non-Hodgkin’s lymphoma 19.81% (21/106) followed by acute myeloid leukemia 15.09% (16/106), then colorectal cancer 13.21% (14/106), pancreatic cancer and acute lymphoblastic leukemia accounting for 5.66% (6/106) each, multiple myeloma 4.72% (5/106), gall bladder cancer 3.77% (4/106), and lung cancer 2.83% (3/106). A total of 138 bacterial isolates were identified. The overall prevalence of gram-negative bacteria was 65.94% (91/138) and for gram-positive bacteria was 34.06% (47/138). The most common bacterial isolation sites were blood 33.32% (46 isolates), urine 29.71% (41 isolates), wound 19.55% (27 isolates), body fluids 9.41% (13 isolates) and sputum 7.96% (11 isolates). The most predominant pathogens were Escherichia coli 30.43 (42/138), Klebsiella pneumonia 14.49% (20/138), Staphylococcus aureus 13.04% (18/138), Sptreptococcus spp. 7.25% (10/138), Pseudomonas spp. 7.25% (10/138), Enterococcus spp. 5.80% (8/138), Staphylococcus spp. 4.35% (6/138), Corynebacterium spp. 3.62% (5/138), Enterobacter spp. 3.62% (5/138), Acinobacter spp. 2.90% (4/138), Serratia marcescens 2.17% (3/138), Proteus mirabilis 1.45% (2). Aeromonas hydrophylia, Citrobacter freundii, Providencia stuartii, Sphingomonas paucimobilis and Stenotropomonas multipholia contributed to 0.72% with one isolate each. For gram-negative Escherichia coli and Klebsiella pneumonia, the extended-spectrum beta-lactamases producers (ESBLs) rates were 38% and 22.22% respectively. For Pseudomonas aerugenosa imipenem-cilastatin resistance rate was 18.84%. For gram-positive bacteria, methicillin-resistant Staphylococcus aureus (MRSA) rate was 28.62%. The vancomycin-resistant Enterococci (VRE) rate was 1.18%.ConclusionGram-negative bacteria were more prevalent as a cause of infection in adult cancer patients with febrile neutropenia at our institution, with Escherichia coli and Klebsiella pneumonia with high ESBLs rates being the most common pathogens. Blood stream infections followed by urinary tract infections were the most common sites of infection. The use of initial antibiotic therapy in febrile neutropenic episodes should be based on local bacterial spectrum and susceptibility/sensitivity patterns to prevent treatment failure with increased morbidity and mortality.

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Section: Discussionsupporting

confidence: 91%

“…Bacterial infections are common in this population. In order to treat effectively, the knowledge of likely pathogens and local bacterial spectrum is very important [ 16-19 ].…”

Section: Discussionmentioning

confidence: 99%

Bacterial Spectrum, Isolation Sites and Susceptibility Patterns of Pathogens in Adult Febrile Neutropenic Cancer Patients at a Specialist Hospital in Saudi Arabia

Sirkhazi

Sarriff

Aziz³

et al. 2014

World J Oncol

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“…In a recent review of P. aeruginosa bacteremia at our institution, half the cases were community acquired, demonstrating that this organism is not necessarily a nosocomial pathogen [5]. Several smaller reports have documented a similar distribution of species among isolated GNB [6,7].…”

Section: Pseudomonas Aeruginosa-still a Frequent Pathogen In Patientsmentioning

confidence: 84%

Pseudomonas aeruginosa—Still a Frequent Pathogen in Patients with Cancer: 11‐Year Experience at a Comprehensive Cancer Center

Rolston

Tarrand

1999

CLIN INFECT DIS

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“…This finding is also similar to previously reported studies in which gram-negative bacilli, especially E. coli and Klebsiella species, were prominent causes of infection. 20,21 There is 63% reduction in risk of hospitalization with levofloxacin prophylaxis. The reduction in hospitalization rate is high as compared to other studies.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic levofloxacin in cancer chemotherapy: a randomized controlled study

Peters¹,

Badyal²,

John³

2018

Int J Res Med Sci

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Background: The patients on cancer chemotherapy are at substantial risk of developing febrile episodes, bacteremia and infection related mortalities, yet the prophylactic use of antimicrobials continues to be a controversial issue. Hence, this study was designed to study the effect of antimicrobial prophylaxis in cancer chemotherapy.Methods: The patients receiving the cancer chemotherapy were randomly divided into two groups. Group A patients received cancer chemotherapy and no prophylactic antimicrobials. Group B patients were given prophylactic levofloxacin with each cancer chemotherapy cycle. Patients were evaluated for febrile episodes, documented infections and hospitalizations. The Eastern Cooperative Oncology Group (ECOG) performance grade and culture sensitivity reports were also recorded.Results: Demographic profile of patients was comparable in both groups. Absolute neutrophil count at 6 weeks was significantly higher with levofloxacin prophylaxis. Levofloxacin prophylaxis led to 92% reduction in risk of having neutropenia in first cycle, 78% reduction in clinically documented febrile episodes during the first chemotherapy cycle (36 % vs 8%, 95% confidence interval 0.08 to 0.56, p<0.001), 88% reduction in risk of developing infections, 63% reduction in risk of hospitalization and 30% decrease in average cost of treatment per patient per day (₹1269.80±220.32 vs. ₹372.21±99.23, p<0.01) as compared to control group. All documented infections were from gram negative bacteria, E. coli being the commonest.Conclusions: Antimicrobial prophylaxis with levofloxacin is beneficial to patients receiving cancer chemotherapy as it decreases the morbidity, in terms of febrile episodes, neutropenia, infections, hospitalizations and it also reduces the cost of overall treatment.

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Febrile neutropenia in cancer patients in Kuwait: microbial spectrum and outcome

Cited by 16 publications

References 9 publications

Bacterial Spectrum, Isolation Sites and Susceptibility Patterns of Pathogens in Adult Febrile Neutropenic Cancer Patients at a Specialist Hospital in Saudi Arabia

Bacterial Spectrum, Isolation Sites and Susceptibility Patterns of Pathogens in Adult Febrile Neutropenic Cancer Patients at a Specialist Hospital in Saudi Arabia

Pseudomonas aeruginosa—Still a Frequent Pathogen in Patients with Cancer: 11‐Year Experience at a Comprehensive Cancer Center

Prophylactic levofloxacin in cancer chemotherapy: a randomized controlled study

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