Antibiotic resistance pattern of bacterial isolates retrieved from febrile neutropenic patients with hematological disorders

Abstract Background Antibiotic resistance is nowadays becoming a threat in the treatment of immunosuppressed patients. The aim of this study was to find out the antibiotic resistance pattern of bacteria isolated from febrile neutropenic patients with hematological disorders so that it would help to select the empirical antibiotic for prompt effective treatment of the febrile neutropenic patients. Methods A cross-sectional descriptive study was conducted at a tertiary care hospital of Nepal from October 2018 to November 2019. Blood was drawn aseptically in blood culture bottles. The bacteria were identified by standard microbiological methods with observation of colony morphology, gram staining and biochemical tests of bacteria. The antibiotic susceptibility tests were done by Kirby Bauer disc diffusion method. Extended Spectrum Beta Lactamase (ESBL) and Metallo Beta Lactamase (MBL) producers, and Methicillin Resistant Staphylococcus aureus (MRSA) were detected by phenotypic methods. Results Of the total 214 blood samples, 33.9% (71) yielded the bacterial growth. Gram negative bacteria were isolated from 23.8% of total samples and Gram-positive bacteria were isolated from 9.3% of the total samples. The Gram negative bacteria isolated were Escherichia coli (7.9%), Klebsiella pneumoniae (4.7%), Citrobacter spp. (4.7%), Acinetobacter spp. (3.7%) and Pseudomonas aeruginosa (2.8%). The Gram-positive bacteria isolated were Staphylococcus aureus (5.6%), Coagulase Negative Staphylococcus (2.3%) and Enterococcus spp. (1.4%). About 66.7% of the total Gram-negative bacteria isolated and 50% of the total Gram-positive bacteria were MDR (Multidrug-resistant). About 19.6% of the total Gram-negative bacteria were ESBL producers and 19.6% of them were MBL producers. About 41.6% of Staphylococcus aureus isolated were MRSA (Methicillin Resistant S. aureus). In our institution, piperacillin-tazobactam is the preferred first choice empirical antibiotic. But 58.8% of the Gram negative organisms were found to be resistant towards piperacillin-tazobactam. Hence there is a prompt necessity to switch to another antibiotic with high sensitivity for effective treatment of the febrile neutropenic patients in our institution. Conclusion Antibiotic surveillance data should be evaluated periodically to select the empirical therapeutic antibiotic for effective treatment of febrile neutropenic patients.