A Study on Clinicomicrobiological Profile of Infections in Febrile Neutropenic Children with Haematological Malignancies in a Tertiary Care Hospital at Chennai, Tamil Nadu, India

Abstract

Introduction: Febrile neutropenia is common with chemotherapy regimens in 25-40% of patient, especially in children and the severity which depends on the chemotherapy regimens. Neutropenic fever is an oncologic emergency that requires immediate treatment with antibiotics. Aim: To isolate and identify bacterial, fungal, parasitic and viral aetiological agents causing infections in febrile neutropenic children with haematological malignancy and to identify the comorbid conditions. Materials and Methods: This cross-sectional study was conducted at the Institute of Microbiology, Madras Medical College Chennai, Tamil Nadu, India, for a period of one year from November 2012 to October 2013. A total of 112 paediatric patients with 129 febrile episodes were included in the study satisfying the inclusion and exclusion criteria. Under strict aseptic precautions samples were collected from patients with signs of infections after obtaining informed consent and were subjected to microbiological detection and identification by conventional culture methods. The data was expressed in terms of frequency and percentages and statistical results were analysed with Microsoft Excel. Results: Among the 129 febrile episodes microbiologically documented infections were 39.5% (51 out of 129 febrile episodes). Bacterial infections were predominant constituting 36.4% followed by 3.1% fungal infection. Bacteremia constituted to about 19.4% of febrile episodes, followed by urinary tract infection about 11.6%, respiratory tract infection 6.2% and oral infection 2.3%. Most of the gram negative isolates were sensitive to amikacin, cefaperazone sulbactam and piperacillin tazozobactam. Gram positive isolates were sensitive to vancomycin, cotrimoxazole and erythromycin. Out of the four fungal isolates three Candida spp. were isolated from oral thrush and one Aspergillus flavus from respiratory tract. All the fungal isolates were 100% sensitive to antifungal agents. Overall mortality due to infection was 18%. Conclusion: In this study, the spectrum of bacteremia among febrile neutropenic patients, appear to be shifting towards gram positive microorganisms with multidrug resistant organisms being common. Emergence of multidrug resistance can be prevented by reviewing periodical modification of empiric antibiotic policy. Therefore, surveillance of antibiotic resistance pattern would be useful for deciding empiric therapy in them.

Keywords

• bacteremia
• bacteriological profile
• chemotherapy
• multidrug resistance