Evaluation of the Distribution and Antimicrobial Susceptibility of Gram-negative Bacteria Isolated from Blood Cultures in Heamatologic Febrile Neutropenia Attacks

Abstract

Objectives: Bacterial bloodstream infections with resistant pathogens in patients with hematological malignancies are increasing due to the more use of new chemotherapeutic agents and prophylactic antibiotics. In this study, it was aimed to determine the epidemiology and resistance rates of gram-negative bacterial pathogens isolated from blood cultures of febrile neutropenic patients with hematological malignancies in order to help the correct administration of empirical antibiotics and to limit resistance. Materials and Methods: Antibiotic susceptibility of gram-negative bacteria, which were grown in the blood cultures of hematological febrile neutropenic patients in a tertiary university hospital between 2019 and 2021 and determined as bloodstream infection, was retrospectively investigated. Results: Between January 1, 2019 and December 31, 2021, a total of 388 gram-negative isolates, which were isolated from blood cultures and evaluated as bloodstream infection, in the febrile neutropenia attacks of patients with hematological malignancies hospitalized in the hematology service were evaluated, and the most common isolated pathogen was found to be Klebsiella spp. (41.7%). When evaluated in terms of multi-drug resistance, it was determined that Klebsiella spp. was in the first and Acinetobacter spp. was in the second place. When evaluated in terms of piperacillin-tazobactam susceptibility, which we frequently use in the empirical treatment of febrile neutropenic patients, 70.3% of Klebsiella spp., 37.7% of Escherichia coli, 86% of Acinetobacter spp. and 67.5% of Pseudomonas spp. were found to be resistant to piperacillin-tazobactam. Carbapenem resistance was also found to be between 29% and 80%. Conclusion: It is noteworthy that all gram-negative strains were highly resistant to piperacillin-tazobactam, which is used as empirical treatment of febrile neutropenia attacks, and that carbapenem resistance was found at a substantial rate. Considering these data may contribute to reducing morbidity and mortality while arranging empirical treatment guidelines and antibiotic management programs in febrile neutropenia attacks seen in hematological malignancy patients both in our hospital and in Turkey.

Keywords

• Febrile Neutropenia
• Hematologic Malignancy
• Antimicrobial Sensitivity
• Multidrug Resistance

Hematolojik Febril Nötropeni Ataklarında Kan Kültürlerinden İzole Edilen Gram-negatif Bakterilerin Dağılımı ve Antimikrobiyal Duyarlılıklarının Değerlendirilmesi

Abstract

Amaç: Hematolojik maligniteleri olan hastalarda dirençli patojenler nedeniyle gelişen bakteriyel kan dolaşımı enfeksiyonları, yeni kemoterapötik ajanların ve profilaktik antibiyotiklerin daha çok kullanılması nedeniyle artmaktadır. Bu çalışmada, ampirik antibiyotiklerin doğru uygulanmasına yardımcı olmak ve direnci sınırlamak için hematolojik malignitesi olan febril nötropenik hastalarda kan kültürlerinde üreyen gram-negatif bakteriyel patojenlerin epidemiyolojisini ve direnç oranlarını belirlemek amaçlanmıştır. Gereç ve Yöntem: Üçüncü basamak bir üniversite hastanesinde 2019-2021 yıllarında hematolojik febril nötropenik hastaların kan kültürlerinde üreyen ve kan dolaşımı enfeksiyonu olarak belirlenen gram-negatif bakterilerin antibiyotik duyarlılıkları retrospektif olarak incelendi. Bulgular: 1 Ocak 2019 ile 31 Aralık 2021 tarihleri arasında hematoloji servisinde yatan hematolojik malignitesi olan hastaların febril nötropeni ataklarında kan kültürlerinden izole edilen ve kan dolaşımı enfeksiyonu olarak değerlendirilen toplam 388 gram-negatif izolat değerlendirmeye alındı, en sık izole edilen patojenin Klebsiella spp. (%41,7) olduğu görüldü. Çoklu ilaca direnç açısından değerlendirildiğinde Klebsiella spp.’nin ilk sırada, Acinetobacter spp.’nin ikinci sırada olduğu belirlendi. Febril nötropenik hastaların ampirik tedavisinde sıklıkla kullandığımız piperasilin-tazobaktam duyarlılığı açısından değerlendirildiğinde, Klebsiella spp.’nin %70,3, Escherichia coli’nin %37,7, Acinetobacter spp.’nin %86 ve Pseudomonas spp.’nin %67,5 oranında dirençli olduğu saptandı. Karbapenem direncinin de %29 ila %80 arasında olduğu görüldü. Sonuç: Febril nötropeni ataklarının ampirik tedavisinde kullanılan piperasilin-tazobaktama tüm gram-negatif suşların yüksek oranda dirençli çıkması ve karbapenem direncinin de azımsanmayacak oranda bulunması dikkat çekicidir. Hem hastanemizde hem de ülkemizde hematolojik maligniteli hastalarda görülen febril nötropeni ataklarında ampirik tedavi kılavuzları ve antibiyotik yönetim programları düzenlenirken, bu verilerin göz önünde bulundurulması morbidite ve mortaliteyi azaltmaya katkıda bulunabilir.

Keywords

• Febril Nötropeni
• Hematolojik Malignite
• Antimikrobiyal Duyarlılık
• Çoklu İlaca Direnç

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