Title: Antimicrobial Susceptibility Pattern of the Blood Stream Infection Isolates in Neutropenic Patients on Chemotherapy for Solid Malignancies
Author: Dr Yazhini K, MBBS., MD.
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.177
Abstract
Background: Empiric broad-spectrum antibiotic therapy has been the cornerstone of the management of fever in patients with chemotherapy-induced neutropenia. In the face of emerging multidrug-resistant organisms, antimicrobial prophylaxis and treatment have become increasingly difficult in these highly compromised patients. Thus, the local data of common pathogens is important to initiate the appropriate empirical antibiotic therapy.
Objectives: To determine the antimicrobial susceptibility pattern of the blood stream infection isolates in neutropenic patients receiving chemotherapy for solid tumours.
Methods: Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method on Mueller-Hinton agar as per Clinical Laboratory Standards Institute (CLSI) guidelines. Antibiotic discs were procured from Himedia, Mumbai. The diameters of zones of inhibition were interpreted according to CLSI standards for each organism. Culture media and antibiotic discs were tested for quality control using standard ATCC strains.
Result: Antimicrobial susceptibility testing was done as per CLSI guidelines. The Gram positive isolates showed 100% susceptibility to Vancomycin. Methicillin resistance was seen among 24% of Staphylococcus epidermidis isolates. Staphylococcus aureus isolates were uniformly susceptible to Methicillin. All the Gram negative isolates were found to be ESBL producers by ESBL phenotypic confirmatory double disc test.
Conclusion: The findings highlight the role of Staphylococcus epidermidis, which is commonly considered as a commensal, as a potential pathogen in neutropenic patients, and necessitate the inclusion of antimicrobials having gram positive coverage in the empirical antimicrobial therapy.
Keywords: Neutropenia, Chemotherapy, Blood stream infection, Solid malignancy, Antimicrobial susceptibility.
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