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Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting

BACKGROUND: Bloodstream infections (BSI) remain a major cause of mortality in patients with malignancies. We present the first report on the microbiological profile of bacteraemia and fungaemia among cancer patients in Ghana. METHODS: From January 2010 through December 2013, we retrospectively analy...

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Autores principales: Obeng-Nkrumah, Noah, Labi, Appiah-Korang, Acquah, Michael Ebo, Donkor, Eric S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4667459/
https://www.ncbi.nlm.nih.gov/pubmed/26628056
http://dx.doi.org/10.1186/s13104-015-1701-z
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author Obeng-Nkrumah, Noah
Labi, Appiah-Korang
Acquah, Michael Ebo
Donkor, Eric S.
author_facet Obeng-Nkrumah, Noah
Labi, Appiah-Korang
Acquah, Michael Ebo
Donkor, Eric S.
author_sort Obeng-Nkrumah, Noah
collection PubMed
description BACKGROUND: Bloodstream infections (BSI) remain a major cause of mortality in patients with malignancies. We present the first report on the microbiological profile of bacteraemia and fungaemia among cancer patients in Ghana. METHODS: From January 2010 through December 2013, we retrospectively analyzed the spectrum of bloodstream pathogens in cancer patients from Korle-Bu Teaching Hospital, Ghana—focusing on multidrug resistant isolates (MDRs). RESULTS: Overall BSI were confirmed in 22 % (n = 93/453) of total blood cultures. Our data highlights a co-dominance of Gram-negative (n = 49/93, 52.6 %) and Gram-positive (n = 40/93, 43.0 %) bacteria with the former less likely to infect children than adults [odds ratio (OR), 0.56; 95 % confidence interval (CI) 0.14–0.91; p value = 0.027]. Staphylococcus epidermidis was the most isolated bacteria (30.1 %; n = 28/93). About 61 % (n = 25/41) of Enterobacteriaceae isolates were resistant to cefotaxime; a majority (n = 24/25, 96 %) of which were MDRs and mostly susceptible to amikacin and levofloxacin. Four (80 %) penicillin resistant streptococci were found; 2 of which were MDRs and sensitive to erythromycin and cefuroxime. Methicillin resistant Staphylococcus aureus and vancomycin resistant enterococci were not identified. In multivariate analysis, the Enterobacteriaceae compared to other organisms were significantly associated with multidrug resistance (adjusted OR, 33.6; 95 % CI 6.41–88.73; p value 0.001). CONCLUSION: MDRs, especially cefotaxime resistant Enterobacteriaceae, are common among patients with cancer in our institution but vary among different patient populations. The results show that empiric antibiotic treatment for cancer patients cannot be done effectively without regard for selective antimicrobial use based on local epidemiologic data.
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spelling pubmed-46674592015-12-03 Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting Obeng-Nkrumah, Noah Labi, Appiah-Korang Acquah, Michael Ebo Donkor, Eric S. BMC Res Notes Research Article BACKGROUND: Bloodstream infections (BSI) remain a major cause of mortality in patients with malignancies. We present the first report on the microbiological profile of bacteraemia and fungaemia among cancer patients in Ghana. METHODS: From January 2010 through December 2013, we retrospectively analyzed the spectrum of bloodstream pathogens in cancer patients from Korle-Bu Teaching Hospital, Ghana—focusing on multidrug resistant isolates (MDRs). RESULTS: Overall BSI were confirmed in 22 % (n = 93/453) of total blood cultures. Our data highlights a co-dominance of Gram-negative (n = 49/93, 52.6 %) and Gram-positive (n = 40/93, 43.0 %) bacteria with the former less likely to infect children than adults [odds ratio (OR), 0.56; 95 % confidence interval (CI) 0.14–0.91; p value = 0.027]. Staphylococcus epidermidis was the most isolated bacteria (30.1 %; n = 28/93). About 61 % (n = 25/41) of Enterobacteriaceae isolates were resistant to cefotaxime; a majority (n = 24/25, 96 %) of which were MDRs and mostly susceptible to amikacin and levofloxacin. Four (80 %) penicillin resistant streptococci were found; 2 of which were MDRs and sensitive to erythromycin and cefuroxime. Methicillin resistant Staphylococcus aureus and vancomycin resistant enterococci were not identified. In multivariate analysis, the Enterobacteriaceae compared to other organisms were significantly associated with multidrug resistance (adjusted OR, 33.6; 95 % CI 6.41–88.73; p value 0.001). CONCLUSION: MDRs, especially cefotaxime resistant Enterobacteriaceae, are common among patients with cancer in our institution but vary among different patient populations. The results show that empiric antibiotic treatment for cancer patients cannot be done effectively without regard for selective antimicrobial use based on local epidemiologic data. BioMed Central 2015-12-01 /pmc/articles/PMC4667459/ /pubmed/26628056 http://dx.doi.org/10.1186/s13104-015-1701-z Text en © Obeng-Nkrumah et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Obeng-Nkrumah, Noah
Labi, Appiah-Korang
Acquah, Michael Ebo
Donkor, Eric S.
Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting
title Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting
title_full Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting
title_fullStr Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting
title_full_unstemmed Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting
title_short Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting
title_sort bloodstream infections in patients with malignancies: implications for antibiotic treatment in a ghanaian tertiary setting
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4667459/
https://www.ncbi.nlm.nih.gov/pubmed/26628056
http://dx.doi.org/10.1186/s13104-015-1701-z
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