title: Emergence of multidrug resistant acinetobacter blood stream infections in febrile neutropenia patients with haematological cancers and bone marrow failure syndromes.
abstract: Acinetobacter infections are fast emerging as a major nosocomial threat across the globe. With a predilection for blood stream infections in critically ill, immunocompromised patients, their presence is now being felt in febrile neutropenics with underlying malignancies and marrow failure. We aimed through this study to ascertain the current circulating pathogens and levels of antimicrobial resistance in blood stream infections in febrile neutropenia patients, with specific emphasis on elucidating acinetobacter and pseudomonas infections. Clinical and laboratory records of all consecutive neutropenic patients with underlying haematological malignancies and marrow failure, admitted to our AIIMS, New Delhi from April 2009 to March 2010 were analysed for blood stream infections, pathogen profiles and antimicrobial resistance. All clinical and microbiological variables were statistically analysed to elucidate potential risk factors, infection patterns and drug resistance trends. Of the 1,165 blood cultures investigated, 105 episodes of blood stream infections were microbiologically confirmed in febrile neutropenia patients. Gram-negative infections (n = 78, 72.9%) dominated with acinetobacter spp (n = 20, 18.7%) emerging as the most common pathogen. Acinetobacter and pseudomonas together were responsible for 42.9% of all blood stream infections. Both acinetobacter and pseudomonas displayed very high resistance to all five major classes of antibiotics, including multidrug resistance (90.0% and 76.9%) and ESBL production (90.0% and 84.6%), respectively. Comparison of infection patterns and resistance levels with reports over the past decade from this centre and other centres across the globe, revealed a striking increase in multidrug resistant acinetobacter blood stream infections in these patients. Multidrug resistant acinetobacter Infections are a fast emerging threat in febrile neutropenia patients and at this centre in general. Similar early trends from some Indian centres and neighbouring developing countries suggest grave concern. These emerging circulating pathogens and drug resistance patterns demand to systematically evaluate antibiotic and hospital infection policies and to sensitise all clinicians to curb this pathogen capable of rapid nosocomial spread.
authors.affiliation: Department of Haematology, All India Institute of Medical Sciences, New Delhi 110029.
authors.forename: Prashant
authors.initials: P
authors.lastname: Sood
authors.forename: Tulika
authors.initials: T
authors.lastname: Seth
authors.forename: Arti
authors.initials: A
authors.lastname: Kapil
authors.forename: Vandana
authors.initials: V
authors.lastname: Sharma
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Dayama
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sharma
authors.forename: Suman
authors.initials: S
authors.lastname: Kumar
authors.forename: Avinash K
authors.initials: AK
authors.lastname: Singh
authors.forename: Pravas
authors.initials: P
authors.lastname: Mishra
authors.forename: Manoranjan
authors.initials: M
authors.lastname: Mahapatra
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D000741:Anemia, Aplastic; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D001855:Bone Marrow Diseases; D000080983:Bone Marrow Failure Disorders; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D024901:Drug Resistance, Multiple, Bacterial; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology*; D006457:Hemoglobinuria, Paroxysmal / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007194:India; D008826:Microbial Sensitivity Tests; D009503:Neutropenia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology*; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies