Bacterial isolates, antimicrobial sensitivity and characteristics of children with febrile neutropenia on treatment for cancer at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Febrile neutropenia is a common complication of chemotherapy induced myelosuppression. It is one of the most common causes of morbidity and mortality among children with cancer undergoing treatment with chemotherapy. At MTRH the bacterial organisms that cause febrile neutropenia are not known. This study aimed to find out the bacterial organisms associated with febrile neutropenia in children with cancer and the patient characteristics. Objective: The main objective of this study was to identify the bacterial organisms associated with febrile neutropenia in children with cancer admitted at MTRH, their sensitivity patterns and the patient characteristics. Methodology: A descriptive cross sectional study was carried out at the Moi Teaching and Referral Hospital, paediatric oncology ward, for a period of 10 months from June 2021 to April 2022. Children in the ward who developed a fever and neutropenia while receiving treatment with chemotherapy were recruited and blood samples were drawn aseptically for blood culture. The blood culture samples were received in the lab and were incubated in the BACT/ALERT automated blood culture machine. The patients’ characteristics in terms of clinical diagnosis and demographic data were presented in frequency tables. Blood culture isolates results were presented in table form and grouped according to gram positive and gram negative bacteria. Antimicrobial sensitivity patterns were plotted in tables against the bacterial isolates cultured. Chi square/Fischer’s exact test were used to analyse and test for association between patient characteristics and bacterial growth. Results: Out of the 110 children included in the study, 66 (60%) were males. The median age of the children was 6.3 (SD 3.7) years. Majority of the patients 71 (64.5%) had a diagnosis of heamatological malignancies with the most common diagnosis being Acute Myeloid Leukaemia (AML). There was a significant association between severity of neutropenia and haematological malignancies p=0.028. From a total of 110 blood culture specimens collected, 31 (28.2%) were positive for bacterial growth. Gram positive bacteria were more frequent at 20 (58.1%). The most common organism from this study was Escherichia coli 6 (18.2%), followed by Staphylococcus aureus at 5 (15.2%). All the bacterial organisms were sensitive to linezolid and vancomycin and also showed good sensitivity towards meropenem at 10/11 (90.9%). High resistance to cephalosporins was noted with ceftriaxone at 5/6 (83.3%), cefepime at 4/7( 57.1%) and ceftazidime 3/4 (75%). Conclusion: The most common malignancy associated with febrile neutropenia was AML. Gram-positive bacteria were the most common source of BSI in patients with febrile neutropenia in our set up. The most common gram negative organism was Escherichia coli while Staphylococcus aureus was the most common gram-positive isolate. The organisms isolated had resistance to cephalosporins and benzylpenicillin but all were sensitive to linezolid and vancomycin. Recommendations: Empirical antimicrobial management of febrile neutropenia in the paediatric oncology unit at MTRH should target gram-positive bacteria. First line antibiotics should be meropenem as monotherapy or in combination with an aminoglycoside such as amikacin.