Karamat Ahmed Karamat, Karamat Ahmed Karamat, Tariq Mehmood Tariq, Abdul Hanan, Muhammad Saleem Siddiqi, Tariq Butt, Masood Anwar, Muhammad Saleem.
Bacterial infections in neutropenic cancer patients.
Pak J Pathol Jan ;9(2):38-43.
Bacterial infections are the commonest cause of morbidity and mortality during the course of chemotherapy in cancer patients because of the resultant severe neutropenia. Therefore institution of antimicrobial therapy at slightest suspicion of infection is indicated in these patients. Key to effective therapy is selection of appropriate antibiotic(s) to which most of the suspected microbes are sensitive. Use of new, broad spectrum antibiotics increase the cost of treatment. Therefore every center shall find out a cost effective therapeutic regimen based on the most prevalent flora in that centre. To achieve this objective, a prospective study was carried out at the department of Microbiology of Armed Forces Institute of Pathology, Rawalpindi on patients receiving chemotherapy for various malignant disorders at the Oncology Department of Combined Military Hospital Rawalpindi. A total of 95 febrile episodes were investigated in 93 neutropenic patients. Gram negative bacteria were found to be responsible for most (57%) of these episodes. The commonest organisms isolated were Klebsiella species which accounted for 18% of all isolates, followed by Pseudomonas species (12%). Other gram negative isolates were lactose fermenting and non-lactose fermenting organisms frequently isolated in nosocomial setting including E. Coli, Enterobacter, Proteus and Acinetobacter. Gram-positive organisms comprised 42% of isolates, Staphylococcus species being the most common. The standard empirical antibiotic regimen for febrile episodes in neutropenic patients employed at our centre included a combination of aminoglycoside (amikacin) and a beta-lactam agent with anti-pseudomonal activity (cefoperazone). Vancomycin was added if there was no response in the first 48 hours. There was a good clinical response to empirical therapy in majority of episodes. Only in 19% episodes vancomycin had to be added. The initial empirical treatment was found to be appropriate by in vitro svscaptibility test-g of tha bacterial isolates.
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