Emergence of Carbapenem resistant Gram negative and vancomycin resistantGram positive organisms in bacteremic isolates of febrile neutropenic patients A descriptive study
This study was conducted to evaluate drug resistance amongst bacteremic isolates of febrile neutropenic patients with particular emphasis on emergence of carbapenem resistant Gram negative bacteria and vancomycin resistant Enterococcus species.
Methods: A descriptive study was performed by reviewing the blood cultures from febrile neutropenic patients in two study periods i.e., 1999-00 and 2001-06.
Blood cultures were performed using BACTEC 9240 automated system. Isolates were identified and sensitivities were done using standard microbiological procedures.
Results: Seven twenty six febrile neutropenic patients were admitted during the study period. A total of 5840 blood cultures were received, off these 1048 (18%) were culture positive.
Amongst these, 557 (53%) grew Gram positive bacteria, 442 (42%) grew Gram negative bacteria, 43 (4%) fungi and 6 (1%) anaerobes. Sixty out of 1048 (5.7 %) positive blood cultures were polymicrobial.
In the Gram negative bacteria, Enterobacteriaceae was the predominant group; E. coli was the most frequently isolated organism in both study periods.
Amongst non- Enterobacteriaceae group, Pseudomonas aeruginosa was the commonest organism isolated during first study period followed by Acinetobacter spp. However, during the second period Acinetobacter species was the most frequent pathogen.
Amongst the Enterobacteriaceae group statistically significant resistance appeared in the second study period against ceftriaxone, quinolone and piperacillin/tazobactam, no resistance observed in this group for imipenem/ meropenem. The susceptibility pattern of Acinetobacter species shifted from sensitive to highly resistant one with significant p values against ceftriaxone, quinolone, piperacillin/tazobactam and imipenem/ meropenem.
Amongst Gram positive bacteria, MRSA isolation rate remained static, vancomycin resistant Enterococcus species emerged in second half of study while no Staphylococcus species resistant to vancomycin was noted.
Conclusion: This rising trend of highly resistant organisms stresses the increasing importance of continuous surveillance system and stewardship of antibiotics as strategies in the overall management of patients with febrile neutropenia.
Author: Seema Irfan, Faiza Idrees, Vikram Mehraj, Faiza Habib, Salman Adil and Rumina Hasan
Credits/Source: BMC Infectious Diseases 2008, 8:80
Published on: 2008-06-09
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