Background and aim Patients (pts) with haematological malignancies and solid tumours undergoing chemotherapy protocols have high risk of developing infectious complications. The screening for multiresistant bacteria (MRB) and antibiotic prophylaxis reduces mortality rate as well as the incidence of bloodstream infections (BSI). Colonisation with MRB is considered predictive for systemic infections, which are truly concerning among these patients. The aim was to evaluate morbidity and mortality in patients with MRB colonisation.
Methods Between 1stNovember 2016 and 31st January 2017, all pts with malignancies that have been hospitalised in the Paediatric Department of Clinical Institute Fundeni were investigated for colonisation with MRB by obtaining rectal swab, nasal and pharyngeal effusion and urine cultures. They received polichemotherapy treatment. We analysed presence of carbapenemase (CARB+) producing gram negative bacteria, extended spectrum beta-lactamases producing (ESBL+) bacteria, vancomycin resistant enteroccoci (VRE). All pts with digestive colonisation with CARB+ and ESBL+ bacteria received treatment for internal decontamination with oral Gentamicin and Colistin meanwhile those with VRE received only oral Gentamicin.
Results Over a period of three months, 52 pts, range 1-17y, were monitored weekly throughout hospitalisation. 26 pts (50%) were identified to be colonised or had infections with MR bacteria. All these pts were hospitalised in the last six months. 16 out of 26 pts had multiple colonisation. Sex ratio M/F was 12/14. After performing decontamination, 14/26 pts had negative bacteriological tests. Pts who experienced BSI (5/26) with MRB were neutropenic. All neutropenic pts received empirical antibiotic therapy (Piperacillin – tazobactam) from the first febrile episode, followed by specific treatment in accordance with the antibiogram, using combinations of antibiotics from different pharmacotherapeutical groups. 3 pts with BSI died. 1 patient colonised with VRE developed neutropenic colitis and died. After a follow-up period of 90 days overall survival in the cohort was 84.61%.
ConclutionS Incidence of colonisation with MRB among pts with hematologic malignancies and solid tumours admitted to our clinic was 50%. MRB sepsis occurred in neutropenic pts who received intensive chemotherapy for high-risk forms of the disease or relapse. MRB screening is part of efforts to prevent and manage future infections with this type of bacteria.
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