Prevalence of Antimicrobial Resistant Bacterial Infections among Neutropenic Patients in Hiwa Cancer Hospital, Sulaimani, Iraq

Authors

  • Paiwast Jaza Ameen Hiwa Cancer Teaching Hospital, Sulaimani, Directorate of Health, Kurdistan region, Iraq https://orcid.org/0009-0003-2994-673X
  • Kawa Fariq Dizaye Department of Pharmacology, College of Medicine, Hawler Medical University, Kurdistan Region, Iraq https://orcid.org/0000-0003-1739-8273
  • Safeen Othman Mahmood Department of Clinical Microbiology and Infectious Diseases, Sulaimani Directorate of Health, Kurdistan Region, Iraq

DOI:

https://doi.org/10.54133/ajms.v6i2.713

Keywords:

Antibiotic resistance, Collateral damage, Febrile neutropenia, MDR, MRS strains, XDR

Abstract

Background: Febrile neutropenia (FN) is one of the most serious complications of cancer chemotherapies. To avoid life-threatening complications from treatment delays, appropriate empirical antibiotics treatment should be initiated. Objective: To highlight the common bacteria encountered at Hiwa Hospital, the current state of the hospital's antibiogram and recommendations for resistance management. Method: From January 2021 to December 2022, we retrospectively collected culture-confirmed FN cases from the Hiwa Hospital system database in Sulaimani, Iraq. Results: We collected 144 culture-confirmed cases, with ninety-four from hematology wards and fifty from oncology wards. The participants’ ages ranged from 2–79 years. Seventy-three of them were male, with a male-to-female ratio of 1:0.9. Gram-negative bacteria comprised 50.7% of the total cases, 47.9% had gram-positive bacteria, and only 1.4% had fungal growth. The most common isolated pathogens were Staphylococci species (38.9%), E. coli (29.2%), Klebsiella pneumoniae (9%), Streptococcus spp. (8.3%), and Pseudomonas spp. (8.3%). A large number of Staphylococcus spp. were resistant to amoxicillin/clavulanic acid, ceftriaxone, cefepime, and levofloxacin. In contrast, E. coli was resistant to ceftriaxone, ceftazidime, cefepime, ciprofloxacin, meropenem, and piperacillin/tazobactam. Klebsiella spp. exhibited significantly higher levels of resistance to amikacin, cefepime, and ciprofloxacin. MRS strains were found in 48.2% of Staphylococci spp., 74% of gram-negative bacteria, and 12.3% of extensive drug-resistant (XDR) isolates. Conclusions: There is a high prevalence of antibacterial resistance among cancer patients, which contributes to quinolone-induced collateral damage.

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References

Gudiol C, Carratalà J. Antibiotic resistance in cancer patients. Expert Rev Anti Infect Ther. 2014;12(8):1003-1016. doi: 10.1586/14787210.2014.920253. DOI: https://doi.org/10.1586/14787210.2014.920253

Danielsen AS, Franconeri L, Page S, Myhre AE, Tornes RA, Kacelnik O, et al. Clinical outcomes of antimicrobial resistance in cancer patients: a systematic review of multivariable models. BMC Infect Dis. 2023;23(1):247. doi: 10.1186/s12879-023-08182-3. DOI: https://doi.org/10.1186/s12879-023-08182-3

Cameron D. Management of chemotherapy-associated febrile neutropenia. Br J Cancer. 2009;101 Suppl 1(Suppl 1):S18-22. doi: 10.1038/sj.bjc.6605272. DOI: https://doi.org/10.1038/sj.bjc.6605272

Raheja R, Reddy N, Patel T, Kilambi S, Mathew AA, Majeed A. Classification of chemotherapy-induced febrile neutropenic episodes into one of the three febrile neutropenic syndromes. Cureus. 2023;15(8):e42843. doi: 10.7759/cureus.42843. DOI: https://doi.org/10.7759/cureus.42843

Taplitz RA, Kennedy EB, Bow EJ, Crews J, Gleason C, Hawley DK, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. J Clin Oncol. 2018;36(14):1443-1453. doi: 10.1200/JCO.2017.77.6211. DOI: https://doi.org/10.1200/JCO.2017.77.6211

Joudeh N, Sawafta E, Abu Taha A, Hamed Allah M, Amer R, Odeh RY, et al. Epidemiology and source of infection in cancer patients with febrile neutropenia: an experience from a developing country. BMC Infect Dis. 2023;23(1):106. doi: 10.1186/s12879-023-08058-6. DOI: https://doi.org/10.1186/s12879-023-08058-6

Alves J, Abreu B, Palma P, Alp E, Vieceli T, Rello J. Antimicrobial stewardship on patients with neutropenia: A narrative review commissioned by microorganisms. Microorganisms. 2023;11(5):1127. doi: 10.3390/microorganisms11051127. DOI: https://doi.org/10.3390/microorganisms11051127

Rattu MA. Prevention and treatment of chemotherapy-induced febrile neutropenia in adults. US Pharm. 2023;48(6):25-30.

Mettler J, Simcock M, Sendi P, Widmer AF, Bingisser R, Battegay M, et al. Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study. BMC Infect Dis. 2007;7:21. doi: 10.1186/1471-2334-7-21. DOI: https://doi.org/10.1186/1471-2334-7-21

Alali M, David MZ, Danziger-Isakov LA, Elmuti L, Bhagat PH, Bartlett AH. Pediatric febrile neutropenia: Change in etiology of bacteremia, empiric choice of therapy and clinical outcomes. J Pediatr Hematol Oncol. 2020;42(6):e445-e451. doi: 10.1097/MPH.0000000000001814. DOI: https://doi.org/10.1097/MPH.0000000000001814

Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011;52(4):e56-93. doi: 10.1093/cid/cir073. DOI: https://doi.org/10.1093/cid/cir073

Berild D, Mohseni A, Diep LM, Jensenius M, Ringertz SH. Adjustment of antibiotic treatment according to the results of blood cultures leads to decreased antibiotic use and costs. J Antimicrob Chemother. 2006;57(2):326-330. doi: 10.1093/jac/dki463. DOI: https://doi.org/10.1093/jac/dki463

Drew RH. Prevention and treatment of infections in neutropenic cancer patients. In: Zeind CS, Carvalho MG, (Eds.), Applied Therapeutics: The Clinical Use of Drugs, (11th Ed.), Philadelphia: Wolters Kluwer Health; 2018. p. 1553–1570.

Vahedian-Ardakani HA, Moghimi M, Shayestehpour M, Doosti M, Amid N. Bacterial spectrum and antimicrobial resistance pattern in cancer patients with febrile neutropenia. Asian Pac J Cancer Prev. 2019;20(5):1471-1474. doi: 10.31557/APJCP.2019.20.5.1471. DOI: https://doi.org/10.31557/APJCP.2019.20.5.1471

Paul M, Bhatia M, Rekha US, Diksha L, Omar BJ, Gupta P. Microbiological profile of blood stream infections in febrile neutropenic patients at a tertiary care teaching hospital in Rishikesh, Uttarakhand. J Lab Physicians. 2020;12(2):147-153. doi: 10.1055/s-0040-1716661. DOI: https://doi.org/10.1055/s-0040-1716661

Gustinetti G, Mikulska M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence. 2016;7(3):280-297. doi: 10.1080/21505594.2016.1156821. DOI: https://doi.org/10.1080/21505594.2016.1156821

Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016;27(Suppl 5):v111-v118. doi: 10.1093/annonc/mdw325. DOI: https://doi.org/10.1093/annonc/mdw325

Makhani SS, Abro C, Ketineni S, Zhu X, Prakash V, Agarwal I, et al. Inpatient burden and clinical outcomes of febrile neutropenia in cancer patients: a national inpatient sample database analysis. Blood. 2022;140(Suppl 1):5154-5155. doi: 10.1182/blood-2022-165527. DOI: https://doi.org/10.1182/blood-2022-165527

Ali J, Kumari R, Siddiqui AA, Nasir M, Sabir S, Hasan S, et al. Febrile neutropenia in patients receiving chemotherapy; an observational study highlighting its association with hematological parameters on gender basis. Cancer Sci Res. 2018;5(1):1-5. doi: 10.15226/csroa.2018.00140.

Poveda CS, Caamaño CC, Coloma EC, Rodríguez AP, Ramírez NC. Prevalence of germs with multi antibiotic resistance in bacteremia associated with febrile neutropenia in hospitalized cancer patients. A single-center study. Oncología (Ecuador). 2022;32(2):157-168. doi: 10.33821/631. DOI: https://doi.org/10.33821/631

Trecarichi EM, Tumbarello M. Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer: current epidemiology and clinical impact. Curr Opin Infect Dis. 2014;27(2):200-210. doi: 10.1097/QCO.0000000000000038. DOI: https://doi.org/10.1097/QCO.0000000000000038

Parodi RL, Lagrutta M, Tortolo M, Navall E, Rodríguez MS, Sasia GF, et al. A multicenter prospective study of 515 febrile neutropenia episodes in Argentina during a 5-year period. PLoS One. 2019;14(10):e0224299. doi: 10.1371/journal.pone.0224299. DOI: https://doi.org/10.1371/journal.pone.0224299

Mahar U, Anwar N, Fatima N, Hassan J, Shamsi T. Emerging antimicrobial resistance in febrile neutropenia: Is it high time to evaluate quality control measures? Pak J Med Sci. 2020;36(6):1246-1251. doi: 10.12669/pjms.36.6.2138. DOI: https://doi.org/10.12669/pjms.36.6.2138

Safari LC, Mloka D, Minzi O, Dharsee NJ, Reuben R. Prevalence of blood stream infections and associated factors among febrile neutropenic cancer patients on chemotherapy at Ocean Road Cancer Institute, Tanzania. Infect Agent Cancer. 2023;18(1):52. doi: 10.1186/s13027-023-00533-8. DOI: https://doi.org/10.1186/s13027-023-00533-8

Lubwama M, Phipps W, Najjuka CF, Kajumbula H, Ddungu H, Kambugu JB, et al. Bacteremia in febrile cancer patients in Uganda. BMC Res Notes. 2019;12(1):464. doi: 10.1186/s13104-019-4520-9. DOI: https://doi.org/10.1186/s13104-019-4520-9

Morris PG, Hassan T, McNamara M, Hassan A, Wiig R, Grogan L, et al. Emergence of MRSA in positive blood cultures from patients with febrile neutropenia--a cause for concern. Support Care Cancer. 2008;16(9):1085-1088. doi: 10.1007/s00520-007-0398-5. DOI: https://doi.org/10.1007/s00520-007-0398-5

Bhat S, Muthunatarajan S, Mulki SS, Archana Bhat K, Kotian KH. Bacterial infection among cancer patients: Analysis of isolates and antibiotic sensitivity pattern. Int J Microbiol. 2021;2021:8883700. doi: 10.1155/2021/8883700. DOI: https://doi.org/10.1155/2021/8883700

Paterson DL. "Collateral damage" from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis. 2004;38(Suppl 4):S341-345. doi: 10.1086/382690. DOI: https://doi.org/10.1086/382690

Baden LR, Bensinger W, Angarone M, Casper C, Dubberke ER, Freifeld AG, et al. Prevention and treatment of cancer-related infections. J Natl Compr Canc Netw. 2012;10(11):1412-1445. doi: 10.6004/jnccn.2012.0146. DOI: https://doi.org/10.6004/jnccn.2012.0146

Bate J, Gibson F, Johnson E, Selwood K, Skinner R, Chisholm J. Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients (NICE Clinical Guideline CG151). Arch Dis Child Educ Pract Ed. 2013;98(2):73-75. doi: 10.1136/archdischild-2013-303634. DOI: https://doi.org/10.1136/archdischild-2013-303634

Duco MR, Przybylski DJ, Cosimi RA, Reeves DJ. Retrospective analysis of vancomycin use in febrile neutropenic patients. Infect Dis Clin Pract. 2020;28(4):204-208. doi: 10.1097/IPC.0000000000000845. DOI: https://doi.org/10.1097/IPC.0000000000000845

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Published

2024-04-26

How to Cite

Ameen, P. J., Dizaye, K. F., & Mahmood, S. O. (2024). Prevalence of Antimicrobial Resistant Bacterial Infections among Neutropenic Patients in Hiwa Cancer Hospital, Sulaimani, Iraq. Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ), 6(2), 48–55. https://doi.org/10.54133/ajms.v6i2.713

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