Microbiological Spectrum and Outcome of Febrile Neutropenia in Paediatric Patients With Leukaemia

Abstract

BACKGROUND Febrile neutropenia is the most common morbidity in leukaemia and one of the most common causes of mortality. The knowledge of pathogens causing bacteraemia and the sensitivity pattern in febrile neutropenia is essential in order to start empirical antimicrobial therapy. MATERIALS AND METHODSWe studied the bacterial spectrum and the antibiotic susceptibility pattern of organisms causing infections in children with febrile neutropenia admitted to Govt. Medical College, Kozhikode, Paediatric Oncohaematology Ward, over a period of one and a half years Jan 2011 to June 2012. Common Pathogens were isolated from blood cultures using Automated (Bactec) methods done in the Dept. of Microbiology. RESULTSBlood samples were collected from 325 febrile patients with neutropenia. Growth was obtained in 101 blood cultures, the rest 224 were sterile. Bacteraemic episodes occurred in 92 cases, of which 27 were the maximum number of isolates of Gram positive bacteria and 21 Gram negative bacteria. Among the Gram-positive cocci, Coagulase-Negative Staphylococci (CoNS) were the predominant isolates (n = 13) followed by Methicillin Resistant Staphylococcus aureus (MRSA) (n = 9). Klebsiella and Acinetobacter species (n = 6) were the predominant pathogens among Gram negative rods followed by Pseudomonas aeruginosa (n = 5). Among the nine fungal pathogens of Candida isolated, one was Candida tropicalis and other significant isolates being Candida glabrata and Candida albicans. The culture grew 33 skin flora being diphtheroids and micrococci and 11 Aerobic spore bearers (contaminants) that were of no significance. All gram-positive isolates were susceptible to vancomycin. Among Gram negative rods, Ceftazidime/Netilmicin was the first line antibiotic in 69% cases. CONCLUSIONThe microbiological profile in febrile neutropenia in children with leukaemia in our population appears to be towards gram positive bacteria.