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Abstract

Background: Most patients with acute leukaemia become repeatedly neutropenic for prolonged periods and therefore are at risk of becoming febrile at some point. Aim:This study aimed at observing the outcome of surveillance stool culture guided selection of antibiotic during febrile neutropenia in acute leukaemia patient. Methodology:This was a case control study conducted in the department of Haematology from March 2017 to February 2018. 30 cases and 30 controls diagnosed case of acute leukaemia patient admitted into Haematology department were enrolled in the study. Surveillance stool culture guided antibiotics was used in cases and empirical antibiotics was given in control during febrile neutropenia. The comparison between two groups was done regarding outcome of fever. Categorical comparisons were performed using chi-square test. Continuous variables were expressed as mean values ± standard deviation and compared using Student's t-test/unpaired t-test. For all statistical tests, P-value less than 0.05 was considered as statistically significant.Result: The mean age was found 33.4±16.9 years in cases and 29.8±14.1 years in control. Males were found 17(56.7%) in cases and 15(50.0%) in controls. Females were 13(43.3%) in cases and 15(30.0%) in controls. 25(83.3%) patients had E. coli and 5(16.7%) had Klebsiella in their surveillance stool culture in case group. Colistin was more sensitive 29(96.7%) followed by meropenem 23(76.7%), amikacin 23(76.7%), pipercillintazobactum 22(73.3%). 25(83.3%) patients were MDRO colonizer and 5(16.7%) were not MDRO colonizer., 60.0% of MDRO colonizer patients had no history of prophylactic antibiotic and 40.0% of MDRO colonizer has history of using prophylactic antibiotic. In case group majority 19(63.3%) patients had defervescence of fever ≤1 day and in control group 21(70.0%) had defervescence of fever >1 day. The mean defervescence of fever was found 2.0±1.9 days in cases and 3.3±2.1 days in controls. Early defervescence of fever (≤1 day) was significantly (p<0.05) higher in case group than control group. The mean duration of antibiotic used was found 5.8±2.0 days in cases and 7.7±3.4 days in controls. Duration of antibiotic used was significantly (p<0.05) longer in control group than case group. 8(26.7%) patients in cases and 16(53.3%) in controls needed for second line antibiotics. Conclusion: Prevalence of MDRO colonization in gut in patient with acute leukaemia is alarmingly high. Selection of antibiotic from individual stool antibiogram leads to earlier defervescence of fever, reducing the need for second line antibiotic in patient acute leukaemia.