Pattern of bacterial infections in neutropenic febrile patients (experience of the Specialized BMT center - Medical city complex - Baghdad, Iraq)

Abstract

BACKGROUND: Infectious complications occur in most of the patients undergoing hemopietic stem cell transplantation (HSCT), these carry high risk of mortality mainly due to Gram-negative bacteria unless effective antibiotic treatment is provided. OBJECTIVES: The aims of the study were to review bacterial isolates from different samples in febrile neutropenic patients underwent HSCT in terms of incidence, types, and antimicrobial resistance, and to assess the efficacy of infection control measures used in transplantation ward. PATIENTS AND METHODS: This is retrospective study. The medical records of a total of 82 patients who underwent HSCT in the Specialized BMT Center, Baghdad Medical City, in 2021 and 2022 were reviewed; for any patient with neutropenic fever (NF), the clinical assessment was made, and samples were taken for culture any sensitivity before starting empirical antibiotics. The study was reviewed by the ethical committee of the hematology transplant center in the Medical City Complex, and since the study is retrospective, no consent is needed from the patient. RESULTS: There were 57 patients who developed NF, two at the time of collection, while 55 patients during transplant. In 16 patients, there was a clinical focus for NF, most commonly respiratory. From 175 samples sent for culture and sensitivity, bacterial growth was detected in 103 samples, and the incidence of bloodstream infection was 53%. Polymicrbial bacterial growth was detected in 6 patients with NF. Gram-positive bacteria were slightly more common than Gram negative. Staphylococcus epidermidis and Burkholderia cepacia were the most common Gram positive and Gram negative, respectively. An increasing number of patients admitted to transplant centers were associated with more infections. Ten out of 13 bacteria were multidrug resistant (MDR). Only two patients died from infection posttransplant. CONCLUSIONS: The predominance of Gram-positive cocci and Burkholderia cepacia complex supported the need to review the adherence to infection control policy. The empirical antibiotic protocol should be guided by local antibiogram, and since the high rate of blood stream infection (BSI) with MDR pathogens, a de-escalating strategy utilizing carbapenems – as advised by the ECIL-4 guidelines – would be more appropriate while awaiting culture result. The ability to quickly identify infections and their susceptibility profile is still crucial for choosing antibiotic therapy.

Keywords

• bacterial infection
• bloodstream infection
• burkholderia cepacia
• neutropenic fever