Microbial and Antibiotic Susceptibility Profile among Isolates of Clinical Samples of Cancer Patients admitted in the Intensive-care Unit at Regional Tertiary Care Cancer Center: A Retrospective Observational Study
Citation Information :
Garg VK, Mishra S, Gupta N, Sachidanand B, Kumar V, Gautam H, Bhatnagar S. Microbial and Antibiotic Susceptibility Profile among Isolates of Clinical Samples of Cancer Patients admitted in the Intensive-care Unit at Regional Tertiary Care Cancer Center: A Retrospective Observational Study. Indian J Crit Care Med 2019; 23 (2):67-72.
Cancer patients in intensive care unit (ICU) are vulnerable for developing multidrug resistant nosocomial infections. The antimicrobial resistance due to inappropriate use of antibiotics results in significant morbidity and mortality in these cancer patients. The present retrospective study was done to describe the antimicrobial sensitivity pattern of common organisms in isolates of clinical samples of patients admitted in ICU at our tertiary care cancer center.
Materials and methods: The study was carried out at ICU of a regional tertiary care cancer center for a period of 1 year from October 2016 to September 2017. All clinical samples were collected and processed for culture and antibiotic susceptibility testing were carried out on isolates as per Clinical Laboratory Standard Institute guidelines.
Results: A total of 644 specimens were collected. Escherichia coli, Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus spp. were most commonly encountered. In positive bacterial cultures, majority were Gram-negative isolates (84.14 %). Klebsiella was the most common gram-negative isolate (34.78%) and Enterococcus spp. were the most common Gram-positive isolates (61.53%). A high level of resistance to various antibiotics was noted among Gram-negative bacteria compared to Gram-positive isolates. Majority of the Gram-negative isolates were sensitive to Imipenem, Meropenem, and Colistin sensitivity among Gram-negative isolates was 100%. Linezolid, Teicoplanin and Vancomycin were most sensitive antimicrobials against the Gram-positive bacteria.
Conclusion: Regular monitoring of the pattern of resistance of bacteriological isolates in cancer patients is critical to develop antibiotic policy to combat these infections and reduce morbidity and mortality.
Kamboj M, Sepkowitz KA. Nosocomial infections in patients with cancer. Lancet Oncol 2009;10:589-597.
Cornejo-Juárez P, Vilar-Compte D, et al. The impact of hospitalacquired infections with multidrug-resistant bacteria in an oncology intensive care unit. Int J Infect Dis 2015;31:31-34.
Barai L, Fatema K, et al. Bacterial profile and their antimicrobial resistance pattern in an intensive care unit of a tertiary care hospital in Dhaka. Ibrahim Med Coll J 2010;4:66-69.
Günseren F, Mamikoðlu L, et al. A surveillance study of antimicrobial resistance of gram-negative bacteria isolated from intensive care units in eight hospitals in Turkey. J Antimicrob Chemother 1999;43:373-378.
Gudiol C, Carratalà J. Antibiotic resistance in cancer patients. Expert Rev Anti Infect Ther 2014;12:1003-1016.
Basak S, Singh P, et al. Multidrug Resistant and Extensively Drug Resistant Bacteria: A Study. Journal of Pathogens. 2016; 2016:4065603.
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Twentysecond Informational Supplement (M100-S22). Wayne, PA, USA: CLSI; 2016.
Bauer AW, Kirby WM, et al. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;45:4936.
European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Ver. 6.0, 2016. EUCAST; 2016.
Singh R, Jain S, et al. Characterization and antimicrobial susceptibility of bacterial isolates: Experience from a tertiary care cancer centre in Delhi. Indian J Cancer 2014;51:47780.
Bhat V, Gupta S, et al. Bacteriological profile and antibiotic susceptibility patterns of clinical isolates in a tertiary care cancer centre. Indian J Med Paediatr Oncol 2016;37:204.
Nazneen S, Mukta K, et al. Bacteriological trends and antibiotic susceptibility patterns of clinical isolates at Government Cancer Hospital, Marathwada. Indian J Cancer 2016;53:583-586.
Karanwal AB, Parikh BJ, et al. Review of clinical profile and bacterial spectrum and sensitivity patterns of pathogens in febrile neutropenic patients in hematological malignancies: A retrospective analysis from a single center. Indian J Med Paediatr Oncol 2013;34:858.
Montassier E, Batard E, et al., de La Cochetière MF. Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance. Eur J Clin Microbiol Infect Dis 2013;32:841-850.
Gudiol C, Aguado JM, et al. Bloodstream infections in patients with solid tumors. Virulence 2016;7:298–308.
Royo-Cebrecos C, Gudiol C, et al. A fresh look at polymicrobial bloodstream infection in cancer patients. PLoS ONE 2017;12(10):e0185768.
Prabhash K, Medhekar A, et al. Blood stream infections in cancer patients: a single center experience of isolates and sensitivity pattern. Indian J Cancer 2010;47:1848.
Ghosh I, Raina V, et al. Profile of infections and outcome in high-risk febrile neutropenia: experience from a tertiary care cancer center in India. Med Oncol Northwood Lond Engl 2012;29:1354–1360.