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  Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 3  |  Page : 452-453
 

The microbial etiology and antimicrobial susceptibility of bloodstream infections in patients with cancer at a private tertiary care hospital in Mumbai, India


Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India

Date of Web Publication24-Feb-2017

Correspondence Address:
T Singhal
Department of Infection Prevention and Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.200650

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 » Abstract 

BACKGROUND: Knowledge of the etiology and antimicrobial susceptibility of blood stream infections in patients with cancer is crucial to design empirical therapy regimes. METHODS: This is a prospective observational study at a tertiary care private hospital in Mumbai, India from Nov 2009 - Dec 2014. RESULTS: A total of 62 episodes of blood stream infections in 57 patients with cancer were recorded during the study period. Analysis was limited to 52 isolates from 49 episodes in 45 patients. Gram negative pathogens caused 77% of these infections; commonest pathogens were E. coli and Klebsiella. High prevalence of antimicrobial resistance was noted. Susceptibility in E. coli, Klebsiella, Acinetobacter and Pseudomonas to 3rd generation cephalosporins, beta lactam beta lactamase inhibitor combinations, carbapenems and amikacin was 4%, 56.5%, 70% and 86% respectively. CONCLUSION: The high rates of antimicrobial resistance in gram negative isolates is alarming.


Keywords: Antimicrobial resistance, blood stream infections, cancer, India


How to cite this article:
Singhal T, Shah S, Naik R. The microbial etiology and antimicrobial susceptibility of bloodstream infections in patients with cancer at a private tertiary care hospital in Mumbai, India. Indian J Cancer 2016;53:452-3

How to cite this URL:
Singhal T, Shah S, Naik R. The microbial etiology and antimicrobial susceptibility of bloodstream infections in patients with cancer at a private tertiary care hospital in Mumbai, India. Indian J Cancer [serial online] 2016 [cited 2017 Mar 25];53:452-3. Available from: http://www.indianjcancer.com/text.asp?2016/53/3/452/200650



 » Introduction Top


Infections are a major cause of morbidity and mortality in patients with cancer. It is a standard recommendation that all patients with neutropenia and fever receive empirical antibiotics till culture results are available. The choice of empirical antibiotics depends on the local and regional epidemiology of infections in this population. Hence, it may not be correct to extrapolate international guidelines to our set up. Indigenous recent data is hence needed to enable correct choice of empirical antibiotics at a particular center and also aid drafting of national guidelines. This study reports the etiology and antimicrobial susceptibility of bloodstream infections in patients with cancer at our institute.


 » Methods Top


This is a prospective observational cohort study conducted at a 770 bedded private multispecialty tertiary care facility in Mumbai, India from November 2009. It has a center for oncology and hematopoetic stem cell transplant that treats all types of solid and hematopoetic malignancies as inpatients and in day care chemotherapy. All patients meeting the criteria of febrile neutropenia undergo at least 1 set of blood cultures (if possible from the central venous access and the peripheral route). Cultures were processed in the bioMerieux automated blood culture system; microbial identification and susceptibility testing is done by Vitek 2. A bloodstream infection was defined as a positive blood culture from the central venous line/port or peripheral venipuncture or both. The etiology of bloodstream infections was calculated; antimicrobial susceptibility to third generation cephalosporins, beta-lactam beta-lactamase inhibitor combinations, aminoglycosides, carbapenems and colistin was collated for Gram-negative organisms and to oxacillin and vancomycin for Gram-positive organisms.


 » Results Top


A total of 62 episodes of bloodstream infections in 57 patients were reported from November 2009 to December 2014. This included 13 episodes of Burkholderia cepacia bacteremia in 12 days care chemotherapy patients in end 2009.[1] These episodes were excluded from analysis to prevent skewing of the data. The analysis was confined to 49 episodes of bacteremia in 45 patients. A total of 52 isolates were recovered (three episodes were polymicrobial). The etiologic distribution of these isolates is depicted in [Figure 1]. Gram-negative organisms were responsible of 77% of these blood stream infections, Gram-positive for 15% and Candida for 8%. The most common Gram-negative pathogens were Escherichia coli and Klebsiella. Coagulase-negative staphylococci and enterococci were the major Gram-positive isolates; there was only one Staphylococcus aureus. Of the four Candida isolates, two were Candida parapsilosis, 1 Candida tropicalis, and 1 was Candida haemulonii.
Figure 1: Microbial etiology of bloodstream infections in patients with cancer

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Antimicrobial susceptibility data were available from the year 2012. [Table 1] depicts the antimicrobial susceptibility of the 23 g negative isolates of E. coli, Klebsiella, Pseudomonas, and Acinetobacter. Resistance to third generation cephalosporins was present in 22/23 isolates. Susceptibility to amikacin was seen in 86%, carbapenems in 70%, beta-lactam beta-lactamase inhibitors (piperacillin-tazobactam, cefoperazone-sulbactam) in 56.5% and to ciprofloxacin in 21%. Colistin susceptibility was 100%. All the enterococcal isolates were vancomycin susceptible. Only 2/4 staphylococcal isolates were methicillin resistant. Three of the four Candida isolates were fluconazole susceptible.
Table 1: Antimicrobial susceptibility of Gram-negative isolates (2012-2014, n=23)

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 » Discussion Top


The results of this small study agree with results of previous studies that report a predominance of Gram-negative isolates as the cause of bloodstream infections in patients with cancer in India.[2],[3],[4],[5] The high prevalence of antimicrobial resistance in Gram-negative isolates is alarming. With resistance to beta-lactam beta-lactamase inhibitor combinations almost 50% and carbapenems 30%, antibiotic options become severely limited. There are not many new antibiotics for Gram-negative organisms on the horizon. Colistin is the last line of defense and with its increasing use, resistance is not far away. In this scenario, it is important that due attention is given to infection control and antimicrobial stewardship. In patients with febrile neutropenia, initiating antimicrobial therapy early is crucial but equally important is quick de-escalation and termination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Singhal T, Shah S, Naik R. Outbreak of Burkholderia cepacia complex bacteremia in a chemotherapy day care unit due to intrinsic contamination of an antiemetic drug. Indian J Med Microbiol 2015;33:117-9.  Back to cited text no. 1
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2.
Mandal PK, Maji SK, Dolai TK, De R, Dutta S, Saha S, et al. Micro-organisms associated with febrile neutropenia in patients with haematological malignancies in a tertiary care hospital in Eastern India. Indian J Hematol Blood Transfus 2015;31:46-50.  Back to cited text no. 2
    
3.
Ghosh I, Raina V, Kumar L, Sharma A, Bakhshi S, Thulkar S, et al. Profile of infections and outcome in high-risk febrile neutropenia: Experience from a tertiary care cancer center in India. Med Oncol 2012;29:1354-60.  Back to cited text no. 3
    
4.
Bakhshi S, Padmanjali KS, Arya LS. Infections in childhood acute lymphoblastic leukemia: An analysis of 222 febrile neutropenic episodes. Pediatr Hematol Oncol 2008;25:385-92.  Back to cited text no. 4
    
5.
Prabhash K, Medhekar A, Ghadyalpatil N, Noronha V, Biswas S, Kurkure P, et al. Blood stream infections in cancer patients: A single center experience of isolates and sensitivity pattern. Indian J Cancer 2010;47:184-8.  Back to cited text no. 5
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