Bacteriological Profile of Bloodstream Infections in Paediatric Oncology Patients with Febrile Neutropenia: A Five-year Ambispective Study at a Tertiary Care Centre in Northern India

Abstract

Introduction: Bloodstream Infections (BSI) are known to be responsible for significant mortality and morbidity. Cancer patients, being immunosuppressed, are more vulnerable to developing infections and often present with Febrile Neutropenia (FN). Aim: To determine the epidemiology, microbiology, and antibiotic susceptibility pattern among paediatric cancer patients admitted with FN. Materials and Methods: This ambispective study was conducted over a period of 5 years, from April 2018 to April 2023, in the Department of Paediatric Oncology in coordination with the Department of Microbiology at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India. Isolates collected from April 2018 to April 2022 were retrospectively evaluated with respect to gender, age, and severity of neutropenia, whereas those analysed prospectively were from May 2022 to April 2023. Data from 328 patients presenting with 420 episodes of FN were obtained, including information on age, gender, the organism isolated, and antibiotic susceptibility pattern. Blood samples were collected in blood culture bottles and incubated at 35±2°C in the automated BACT/ALERT blood culture system. Positive bottles were further subjected to manual identification and antibiotic susceptibility testing of the bacterial isolates using the Kirby Bauer disk diffusion method. The results were interpreted according to the Clinical and Laboratory Standards Institute guidelines of 2023. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) software v.23. Results: A total of 328 patients were admitted over the five-year period, with 420 episodes of FN. The culture positivity rate was 81 out of 420 (19.2%). Among the patients, 50 (61.7%) were males, and 36 (45%) had moderate neutropenia at the time of admission. The most common malignancy was Acute Lymphoblastic Leukaemia (ALL), accounting for 25 cases (30.8%), followed by neuroblastoma with 13 cases (16%) and retinoblastoma with 1 case (1.2%). Coagulase-negative Staphylococci (CoNS) were isolated in 21 cases (25.9%). Furthermore, 12 (75%) of the Staphylococcus isolates and 12 (57.14%) of the CoNS were found to be methicillin-resistant. Among the gram-negative bacteria, Acinetobacter baumanii showed the highest resistance to the tested antibiotics. Conclusion: The majority of cases were moderately neutropenic, and CoNS was found to be the most common pathogen in BSI. None of the isolates were pan drug-resistant. Empiric antibiotic treatment for FN should be tailored to the locally prevalent pathogens and their susceptibility patterns. This approach will aid in appropriate infection control practices, ultimately reducing mortality and morbidity in affected patients.

Keywords

• antimicrobial susceptibility
• paediatric cancers
• retinoblastoma