Bacterial etiology and antibiotic susceptibility in adults with acute leukemias and febrile neutropenia with high-risk factors: Original Research

Abstract

Introduction: Febrile neutropenia is secondary to chemotherapy in the treatment of leukemias, it is a complication that predisposes to bacterial infections of diverse etiology because spinal production is compromised, this is a cause of morbidity and mortality in high neutropenic patients. risk for being the most sensitive group. Antimicrobial resistance poses a serious threat to the world. The general objective of this work determined the frequency of bacterial etiology, in the specific objectives the types of bacteria found were quantified in percentage, the susceptibility and antimicrobial resistance were identified, in addition to their infections, the factors were established high risk of poor prognosis more frequent.

Methods: In this descriptive cross-sectional type, clinical records of the clinical oncology service of the National Oncological Institute “Dr. Juan Tanca Marengo ”Solca_Guayquil. The study period was from January 1, 2013 to December 31, 2014. The sample calculation was probabilistic of 60 cases. Patients with leukemia undergoing chemotherapy and who evolved with febrile leukopenia were included, additionally patients with obvious infectious foci and positive cultures were included. The variables were demographic, clinical characteristics of the leukemia, bacteriological study, antibiotic treatment, and comorbidities. Descriptive statistics are used.

Results: 58 patients entered the study, 30/58 were women (51%). Most with ages from 17 to 20 years old 15/58 cases (25.9%), from 21 to 30 years old 12/58 cases (20.7%). 35/58 cases (60%) corresponded to lymphoblastic leukemias and 23/58 cases (40%). The most frequent infectious focus was gastrointestinal 18% (n = 27), skin and soft tissues with 17% (n = 26), and catheter infections 16% (n = 25). 98 cultures were performed, with 52% positive cultures, 25% ESBL, 4% BLAC. The etiology was E. Coli 26% isolated from blood 29%, the antimicrobial sensitivity was 100% amikacin-na, 100%, imipenem, 100 meropenem, 100% tigecycline, 90% piperazilin tazobactam, 18%, ce-fepime, 50% clindamycin and 50% oxacillin. The infections were gastrointestinal 18%, skin and soft tissue 17%, central catheter 16%, mucositis 12%. The maximum neutropenia is 30 days, with a median neutrophil count 230, with an average fever of 3 days. The risk factors were 17% malnutrition, 15% liver disease, 6% hypertension and diabetes..

Conclusions: The most frequent bacterial etiology was E. Coli. There is a low antibiotic sensitivity for gram negatives in all first through fourth generation cephalosporins in the study antibiograms. There is a profile of low resistance to carbapenemic antibiotics together with amikacin with piperacillin tazobactam. Vancomycin and linezolid do not have bacterial resistance in the ethological presentation for gram positives, the most prevalent was methicillin-resistant staphylococcus aureus BLAC type