Causative infections in childhood cancer patients with febrile neutropenia in Pietersburg Hospital, Limpopo Province, South Africa

Abstract

BACKGROUND Febrile neutropenia is a medical emergency that complicates the clinical course and treatment of both hematological and solid malignancies, potentially worsening the overall outcome and increasing the financial burden. The epidemiology of pathogens is varied, and determines the selection of empiric antibiotic therapy for febrile neutropenia. Empirically piperacillin/tazobactam plus amikacin has been recommended as the most suitable antibiotic for management of febrile neutropenia. There is a lack of local studies to provide advice for antibiotic choice in our setting. OBJECTIVE To identify causative organisms of infection and antibiotic susceptibility patterns in childhood cancer patients with chemotherapy related febrile neutropenia in Pietersburg Hospital Oncology Ward Limpopo Province. METHODS This is a retrospective cross-sectional study that reviewed all the febrile neutropenic episodes in children with cancer and with a positive blood culture during the febrile neutropenia episode. Data collected included patient demographics (date of birth, sex, date of diagnosis) diagnosis, organisms cultured and the antibiotic sensitivity profile. RESULTS There were 152 records of positive blood cultures identified of 348 episodes of febrile neutropenia for 413 patients. The median age of study population is 6years (mean age of 6.8years; range 3 to 11years) with male predominance at (61.2%). The most common cancer diagnosis was Acute Lymphoblastic Leukemia (ALL) (33.6%) followed by Nephroblastoma (15.8%), Acute myeloid leukemia (11.2%), Non- Hodgkin’s lymphoma (9.9%), Hodgkin’s lymphoma (5.9%) and other cancers (15.3%). The majority of causative organisms were gram-positive bacteria (45%) followed by gram-negative bacteria (32.4%) and fungi (6.1%). Gram-positive organisms were statistically significant pathogens causing bacteraemia more often in neutropenic patients than gram-negative organisms with a p value=0.016. The majority (n=102; 67.10%) were sensitive organisms with the minority being multidrug resistant organisms (n=23; 15.1%) and 17.8% were contaminants n=27. The most common gram-positive pathogens were Coagulase negative staphylococcus n=37; (21.6%). The most common multidrug resistant organisms were Klebsiella pneumoniae CRE (10.7 %;), followed by Enterococcus faecium VRE (1.9%), Klebsiella oxytoca CRE (1.3%), Enterococcus faecalis VRE (0.6%), and Staphylococcus aureus MRSA (0.6%). No multidrug resistant fungal organisms were cultured. The majority of organisms were sensitive to the first line empiric therapy piperacillin/tazobactam plus Amikacin (67.10%). Thirty patients died during these febrile neutropenic episodes and case fatality rate was 8.6%. CONCLUSION This study confirmed that the causative bacteria of febrile neutropenia in this study were susceptible to the first line empiric therapy piperacillin/tazobactam plus amikacin, and this regimen is therefore appropriate for this paediatric oncology unit.