The Prevalence of Bacteraemia in Neutropenic Paediatric Cancer Patients on Chemotherapy at the University Teaching Hospital

Abstract

Title: The Prevalence of Bacteraemia in Neutropenic Paediatric Cancer Patients on Chemotherapy at the University Teaching Hospital in Lusaka, Zambia. Background: Bacteraemia in neutropenic paediatric cancer patients can lead to high morbidity and mortality if not treated properly. The prevalence of bacteraemia and antibiotic sensitivities are liable to change according to region and time. The study investigated the pattern of bacteraemia and antibiotic sensitivity patterns in neutropenic paediatric cancer patients at the University Teaching Hospital in Lusaka, Zambia. Methods: A descriptive and analytical cross-sectional study was done at the Paediatric Oncology Ward of the University Teaching Hospital in Lusaka, Zambia. We evaluated 100 neutropenic episodes in 53 paediatric cancer patients with suspected neutropenic sepsis. These were enrolled following a consent procedure. Information was obtained from an interviewer administered questionnaire and the attending physician’s case notes. One millilitre of blood was then drawn for blood culture and sensitivity testing, and another one millilitre for full blood count. Information was entered using Epi info version 7 and analysed using SPSS version 2.1 for windows. Results: The prevalence of bacteraemia in neutropenic paediatric cancer patients in this study was five per cent (5%). Four patients with positive blood cultures were in a critical condition (p value of 0.02). Gram negative organisms were isolated more often than gram positive organisms (80 per cent versus 20 per cent). Gram negative bacterial isolates were Enterobacter agglomerans (20%), Escherichia coli (20%), Pseudomonas aeruginosa (20%), and Klebsiella pneumoniae (20%). One gram positive bacterium [v] isolated was Staphylococcus aureus (20%). All gram negative isolates were from inpatients while the gram positive bacterium isolated was from an outpatient. In antibiotic sensitivity tests, two of four isolates (50%) of gram negative bacteria were sensitive to ciprofloxacin, two of four isolates (50%) were sensitive to gentamicin, and zero of four isolates were sensitive to cefotaxime. Escherichia coli isolate was resistant to ciprofloxacin. In the case of gram positive bacterium, Staphylococcus aureus was sensitive to chloramphenicol and clindamycin but resistant to penicillin and oxacillin. Conclusion: Bacteraemia in paediatric cancer patients at the UTH in Lusaka mostly affects a young population of children (median age 6 years) in advanced stage of their disease. Commonest malignancies involved are leukaemias and lymphomas. Most patients are not infected with HIV. The major causative organisms of bacteraemia are gram negatives (80%) with high antimicrobial resistance to the commonly used antibiotics on the oncology ward. The choice of antibiotic in treating neutropenic paediatric cancer patients with suspected bacteraemia needs to take into account the prevalence of gram negative bacteraemia among in patients and antibiotic resistance of gram negative and gram positive bacteria.