ROLE OF SURVEILLANCE CULTURE IN MANAGEMENT OF NEUTROPENIC PATIENTS
*Dr. Sneha Sharad Bowalekar, MBBS, MD Microbiology
Context: Infections with Multi-drug resistant (MDR) organisms are often associated with increased morbidity and mortality in neutropenic children suffering from various cancers and undergoing chemotherapy. Aims: To assess the presence of MDR bacteria in stool specimen of children who were suffering from various cancers and were admitted for management to the hospital, in order to guide an earlier appropriate antimicrobial therapy. Methods and Material: The study involved pediatric patients of either sex diagnosed with different carcinomas treated at our hospital from June 2018 to January 2019. Stool cultures were sent within 72 hr of hospital admission and other cultures were sent when clinically indicated. MDR was defined as resistance of organism to >=3 classes of antibiotics. Results: A total of 55 stool surveillance samples from 50 pediatric patients showed presence of 67.14% MDR organisms. MDR E. coli was isolated at highest frequency. Equal prevalence of MDR organisms amongst both the sexes was observed (χ 2 = 0.96, P- value= 0.33). Blood cultures showed presence of both Gram positive and Gram-negative organisms. UTI was seen in 11 patients and 13.46% of MDR organisms were isolated from urine. Catheter tip culture isolated gram negative MDR organism. Very low concordance of 0% and 1.8% was found in blood culture and urine culture respectively with that of stool culture in isolation of same bacterial etiological agent. Conclusion: We do not recommend practical use of stool surveillance culture for management of febrile neutropenic patients. Studies are urgently needed to characterize in greater detail the exact colonisation rates in this population so that appropriate infection control, antimicrobial stewardship and treatment protocols can be implemented.
Keywords: Neutropenic, Surveillance, Stool, Children, management.
[Full Text Article]