Pattern of Blood Stream Bacterial Infection in Acute Leukaemic Patients with Febrile Neutropenia during Chemotherapy

Md. Maruf Reza Kabir(1), Md. Raiq Raihan Chowdhury(2), Rabeya Sultana(3), Mily Dey(4), Nasrin Akther(5), Papri Nasrin(6), Nazia Sharmin(7), Ismat Ara Islam(8), Aminur Rahman(9), Sharup Chandra Poddar(10), Md. Salahuddin Shah(11), Md. Saroar Jahan Rajib(12)
(1) Dhaka Medical College, Dhaka, Bangladesh
(2) Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
(3) Kurmitola General Hospital, Dhaka, Bangladesh
(4) Sir Salimullah Medical College, Dhaka, Bangladesh
(5) Dhaka Medical College, Dhaka, Bangladesh
(6) Sir Salimullah Medical College, Dhaka, Bangladesh
(7) Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
(8) Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
(9) Sheikh Hasina Medical College, Tangail, Bangladesh, Bangladesh
(10) Dhaka Medical College, Dhaka, Bangladesh
(11) Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
(12) National Institute of Cancer Research & Hospital, Dhaka, Bangladesh

Abstract

Introduction: Febrile neutropenia due to blood stream infections are associated with increased mortality and morbidity in immunocompromised acute leukaemia (AL) patients. This study analysed the pattern of blood stream bacterial infection in AL patients with febrile neutropenia during chemotherapy cycle. Objective: To study the pattern of blood stream bacterial infection in acute leukaemic patients with febrile neutropenia during chemotherapy cycle. Materials and method: This cross-sectional observational study was conducted in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2021 to June 2022, following ethical clearance. Total 70 admitted AL patients with febrile neutropenia during chemotherapy were included. After getting written informed consent, a detailed history, thorough clinical examination and necessary investigations were carried out in each patient. Blood culture was analysed by BACTEC 9240 system and antibiotic susceptibility testing was performed by disc diffusion method. Data were collected in separated case record form and analysed by SPSS-24.0. Data analysis and presentation was made by statistical software SPSS 24 windows version 10. Statistical analysis was done by Chi-square test, Student’s t-test. Result: Mean age of study patients was 34.14±16.93 (SD) years with male preponderance (57.1%). Maximum study patients had acute myeloid leukaemia (51.4%), and rest had acute lymphocytic leukaemia (44.3%) and mixed type (4.3%). Along with fever, maximum patients had respiratory symptoms (48.6%) and gastro-intestinal symptoms (28.6%). Thirteen patients (18.6%) had positive bacterial growth, wherein Klebsiella (53.8%) was the most common organism, followed by Acinetobacter (23.1%), E. coli (7.7%), Achromobacter (7.7%), and Staphylococcus (7.7%). Colistin was the most sensitive antibiotic to gram negative bacteria, while ceftriaxone was the most resistant antibiotic. Conclusion: Gram negative bacteria, especially Klebsiella was the most common organism in culture positive AL patients with febrile neutropenia during chemotherapy cycle. While Colistin was found to be the most sensitive antibiotic for Gram negative organisms.

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References

Baden LR, Swaminathan S, Anga rone M, Blouin G, Camins BC, Casper C., et al. Prevention and Treatment of Cancer-Related Infections, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 2016;14(7): 882–913.

Bhardwaj PV, Emmich M, Knee A, Ali F, Walia R, Roychowdhury P, et al. Use of MASCC score in the inpatient management of febrile neutropenia: a single-center retrospective study. Support Care Cancer. 2021 Oct;29(10):5905-5914.

Puerta-Alcalde P, Cardozo C, Suárez-Lledó M, Rodríguez-Núñez O, Morata L, Fehér C, et al. Current time-to-positivity of blood cultures in febrile neutropenia: a tool to be used in stewardship de-escalation strategies. Clin Microbiol Infect. 2019 Apr;25(4):447-453

Siddiqui B, Azmat R, Tikmani SS, Rafi S, Syed B, Khan MT, et al. Frequency of bloodstream infection in febrile neutropenic patients, experience from a developing country. Ann Med Surg (Lond). 2018 Sep 12;34:71-74.

Bhat S, Muthunatarajan S, Mulki SS, Bhat KA, Kotian KH. Bacterial Infection among Cancer Patients: Analysis of Isolates and Antibiotic Sensitivity Pattern. International Journal of Microbiology, 2021; 8883700:1-7. [Accessed from: https://doi.org/10.1155/2021/8883700]

Sirkhazi M, Sarriff A, Aziz NA, Almana F, Arafat O, Shorman M. Bacterial Spectrum, Isolation Sites and Susceptibility Patterns of Pathogens in Adult Febrile Neutropenic Cancer Patients at a Specialist Hospital in Saudi Arabia. World J Oncol. 2014 Dec;5(5-6):196-203.

Kokkayil P, Agarwal R, Mohapatra S, Bakshi S, Das B, Sood S, et al. Bacterial profile and antibiogram of blood stream infections in febrile neutropenic patients with haematological malignancies. J Infect Dev Ctries. 2018 Jun 30;12(6):442-447.

Siddaiahgari S, Manikyam A, Kumar KA, Rauthan A, Ayyar R. Spectrum of systemic bacterial infections during febrile neutropenia in pediatric oncology patients in tertiary care pediatric center. Indian J Cancer. 2014 Oct-Dec;51(4):403-5.

Sampagar A, Ritesh BR, Shiv D, Ghagne SC, Patil N, Pawashe P. Retrospective Analysis of Bacterial Isolates during Blood Stream Infections in Children with Chemotherapy-induced Febrile Neutropenia: A Single Centre Experience. Indian J Med Paediatr Oncol 2021; 42(06): 540-546.

Sarmiento-Wilches, P, Anteliz-Díaz A, Silva-Sánchez M, Cuesta-Armesto M, & Bello-Suárez, A. Bloodstream infections in pediatric patients with febrile neutropenia in a reference center from Bucaramanga, Colombia. Revista Latinoamericana de Infectología Pediátrica, 2022; 35(1): 12–21.

Babu KG, Lokanatha D, Lakshmaiah KC, Suresh Babu MC, Jacob LA, Bhat GR, et al. Bloodstream infections in febrile neutropenic patients at a tertiary cancer institute in South India: A timeline of clinical and microbial trends through the years. Indian J Med Paediatr Oncol. 2016 Jul-Sep;37(3):174-82.

Mangaraj J, Barkataki D, Mohan DG. Gram negative bacilli causing blood stream infection in febrile neutropenic patients in a tertiary care centre. International Journal of Contemporary Medical Research 2017;4(7):1599-1603.

Perdikouri EIA, Arvaniti K, Lathyris D, Apostolidou Kiouti F, Siskou E, Haidich AB, et al. Infections Due to Multidrug-Resistant Bacteria in Oncological Patients: Insights from a Five-Year Epidemiological and Clinical Analysis. Microorganisms. 2019 Aug 21;7(9):277.

Kinnunen U. Blood culture findings during neutropenia in adult patients with acute myeloid leukaemia. Oulu: University of Oulu; 2010. [Accessed from: http://urn.fi/urn:isbn:9789514263231]

Authors

Md. Maruf Reza Kabir
marufrumi@gmail.com (Primary Contact)
Md. Raiq Raihan Chowdhury
Rabeya Sultana
Mily Dey
Nasrin Akther
Papri Nasrin
Nazia Sharmin
Ismat Ara Islam
Aminur Rahman
Sharup Chandra Poddar
Md. Salahuddin Shah
Md. Saroar Jahan Rajib
Author Biographies

Md. Maruf Reza Kabir, Dhaka Medical College, Dhaka

Registrar, Department of Haematology, Dhaka Medical College, Dhaka, Bangladesh

Md. Raiq Raihan Chowdhury, Bangabandhu Sheikh Mujib Medical University, Dhaka

Assistant Professor of Haematology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka

Rabeya Sultana, Kurmitola General Hospital, Dhaka

Junior consultant, Kurmitola General Hospital, Dhaka

Mily Dey, Sir Salimullah Medical College, Dhaka

Medical Officer, Sir Salimullah Medical College, Mitford, Dhaka

Nasrin Akther, Dhaka Medical College, Dhaka

Medical Officer, Dhaka Medical College Hospital, Dhaka

Papri Nasrin, Sir Salimullah Medical College, Dhaka

Medical Officer, Sir Salimullah Medical College, Mitford, Dhaka

Nazia Sharmin, Bangabandhu Sheikh Mujib Medical University, Dhaka

Medical Officer, Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka

Ismat Ara Islam, Bangabandhu Sheikh Mujib Medical University, Dhaka

Medical Officer, Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka

Aminur Rahman, Sheikh Hasina Medical College, Tangail, Bangladesh

Junior Consultant, Department of Medicine, Sheikh Hasina Medical College, Tangail, Bangladesh

Sharup Chandra Poddar, Dhaka Medical College, Dhaka

Department of Haematology, Dhaka Medical College, Dhaka

Md. Salahuddin Shah, Bangabandhu Sheikh Mujib Medical University, Dhaka

Professor of Haematology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka

Md. Saroar Jahan Rajib, National Institute of Cancer Research & Hospital, Dhaka

Assistant registrar, National Institute of Cancer Research & Hospital, Mohakhali, Dhaka

1.
Kabir MMR, Chowdhury MRR, Sultana R, Dey M, Akther N, Nasrin P, et al. Pattern of Blood Stream Bacterial Infection in Acute Leukaemic Patients with Febrile Neutropenia during Chemotherapy. Haematol J Bangladesh [Internet]. 2023 Dec. 31 [cited 2024 Apr. 17];7(2):82-8. Available from: https://journal.hematologybd.org/index.php/haematoljbd/article/view/115

Article Details

How to Cite

1.
Kabir MMR, Chowdhury MRR, Sultana R, Dey M, Akther N, Nasrin P, et al. Pattern of Blood Stream Bacterial Infection in Acute Leukaemic Patients with Febrile Neutropenia during Chemotherapy. Haematol J Bangladesh [Internet]. 2023 Dec. 31 [cited 2024 Apr. 17];7(2):82-8. Available from: https://journal.hematologybd.org/index.php/haematoljbd/article/view/115

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