Microbiological profile and antimicrobial susceptibility patterns of blood stream infections in febrile neutropenic patients with hematological malignancies in a tertiary care hospital, Kolkata

Abstract

Blood stream infection (BSI) in febrile neutropenic (FN) patients with hematological malignancy is a common manifestation with high mortality rate. To reduce mortality knowledge of pathogens causing BSI and their antimicrobial susceptibility patterns are required for timely initiation of appropriate antimicrobial therapy. This study was aimed to characterize the pathogenic spectrum and antimicrobial resistance patterns of BSI in these patients. In this cross-sectional study patients admitted in the Hematology department over a period of one year with laboratory confirmed positive blood cultures were enrolled. Information regarding demographic profiles and microbiological profiles were recorded. Standard procedures were applied to identify the isolates and their resistance patterns in positive blood culture. Data was collected and analyzed on MS-Excel sheet with various charts and tables. During the study period of one year 198 episodes of BSI recorded in 147 FN patients. Majority of isolates were Gram-negative bacilli (GNB: n=107, 54.04%). Among GNB (n=34, 31.77%) was most frequently isolated and in Gram-positive cocci (GPC) majority isolated was (n=37, 62.71%). (n=12, 37.5%) was the commonest fungal pathogen isolated. Susceptibility to penicillin, clindamycin and quinolones were least among GPC. Among GNB higher resistance patterns were observed against ceftazidime, cefepime, cefoperazone-sulbactam, piperacillin-tazobactam and meropenem. All isolates were resistant to fluconazole. This study revealed a significant increase in proportion of Gram-negative non-fermenting bacteria (GNNFB). These findings highlight the necessity for regular revision of institutional antimicrobial policy which will reduce mortality as well as development of resistant pathogens.