Bloodstream Infections In Cancer Patients In Central India: Pathogens And Trends Of Antimicrobial Resistance Over A Five-Year Period.
Authors: Choudhari Sonali , Gawande Ruchita , Watchmaker Jerestin , Bamnote Pooja , Mishra Pradeep , Dwivedi Pankaj 
Published: June 2024

Introduction : Bloodstream infection (BSI) is a common complication with a high fatality rate in cancer patients. There are noticeable variations in the epidemiology of BSI over time and among different countries. Infections due to multidrug resistant organisms (MDROs) like extended spectrum beta-lactamases (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE) are increasing. This may lead to inadequate empirical antibiotic therapy, increasing the antimicrobial resistance (AMR) problem and unfavorable outcomes in these immunocompromised patients.
Aim : There is paucity of data pertaining to AMR in such vulnerable patients from developing countries like India. The aim of this study was to investigate the distribution of the bacterial pathogens causing BSI and the AMR trend in cancer patients in central India.
Methodology: This single-center retrospective observational study was conducted in a tertiary care cancer hospital. Patients with solid organ and hematological malignancies, both adults and pediatric, who had blood cultures sent to the microbiology laboratory from January 2018 to December 2022 were included. Blood cultures were processed using the BacT/ALERT 3D system (BioMerieux, France), and the identification of the bacteria and their antimicrobial susceptibility (AST) was performed using the Vitek 2 compact system (BioMerieux, France). Electronic medical records and microbiology lab records were used to retrieve the demographic and microbiological data. Microsoft Excel (Microsoft Excel, RRID:SCR_016137) was used to enter and tabulate the data. Statistical analysis was performed using SPSS version 29 (RRID:SCR_002865).
Results:  A total of 687 isolates from 524 patients were studied. Gram-negative bacteria (64%) were commonest cause of BSI in the studied patients followed by Gram-positive cocci (25%) and fungal isolates (9%). Ten cases were polymicrobial.
 Eschereshchia coli (E.coli) (n=140) was the most common among the isolated pathogens followed by Klebsiella species (n=103), Pseudomonas species (n=102), and coagulase negative staphylococci (n=92). Amongst the 140 isolates of E.coli, 66% were extended spectrum β-lactamases (ESBL) producers and 26% were resistant to carbapenem. Among the 130 isolated Klebsiella species, 50% were carbapenem resistant and 36% were ESBL producers.
Amongst enterobacterales, the CRE rate was 34%. Carbapenem resistance was seen in 25% of Pseudomonas species and 53% of Acinetobacter species isolates. Klebsiella species were the most resistant pathogen isolated.
Coagulase-negative staphylococci (CONS) comprised 56% of all Gram-positive isolates, followed by Staphylococcus aureus (36%), enterococci species (11%), and streptococci species (3%). Methicillin resistance was 60% in CONS and 64% in Staphylococcus aureus. One vancomycin resistant enterococci (VRE) was isolated.
Non-albicans candida was the most common fungal pathogen. The sensitivity to fluconazole was 84% in non-albicans candida species while only one isolate of Candida albicans was resistant to fluconazole.
The trend of pathogens was insignificant over five years with Gram-negative bacteria being the commonest. Also, there was no significant change in the trend of ESBL and CRE resistance pattern over five years.
Conclusion: Gram-negative bacteria were the most common isolated pathogens from BSI with higher antimicrobial resistance rate in cancer patients. The CRE rate of 34% is alarming, limiting the choices of empirical antibiotic therapy.