Febrile neutropenia remains one of the major concerns of intensive chemotherapy and contributes significantly to morbidity, health care expenditure and mortality. Colonization of gut by MDR bacteria is regarded as a potential risk factor for subsequent infection with the same organism during febrile neutropenia. In this study, we aim to find the profile of surveillance stool culture and its association with febrile neutropenia in patients of acute leukemia undergoing induction chemotherapy.
Newly diagnosed patients of acute leukemia eligible for intensive chemotherapy were recruited for the study. Baseline stool microscopy and culture sensitivity was done to identify colonization with pathogenic bacteria. Blood and other samples were collected during febrile neutropenia. Association between surveillance stool culture and subsequent infections were studied.
A total of 106 patients were recruited from November 2015 to March 2017. 59 patients were pediatric AL with median age of 10 years and 47 patients were adult AL with median age of 33 years. 68.86% of patients had gut colonization with bacteria of which 33.01% were MDR while 35.84% were non-MDR. Most common MDR bacteria colonizing gut were E. Coli (62.16%) and Klebsiella Pneumonia (21.82%). A total of 264 blood cultures were taken from 68 patients who developed 114 episodes FN during induction. Blood culture positivity rate was 17.80% with 68.08% of the isolates being MDR. Most common MDR isolates were Klebsiella (28.12%) and pseudomonas (18.75%). 34.28% of patients colonized with MDR bacteria developed MDR sepsis during induction compared to 23.68% non MDR colonizers. Induction mortality was 20% in MDR colonizers compared to 10.52% in non-colonizers.
Our study suggests that a significant proportion of patients are colonized with MDR bacteria and there is a high prevalance of MDR sepsis during induction. MDR sepsis and induction mortality were higher in patients colonized with MDR bacteria compared to non MDR bacteria.
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All authors have declared no conflicts of interest.