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Fighting the Rising Spectre of Tough Bugs in Tough Clinical Scenario: A Ten Year Experience from a Hemato-Oncology Centre in Tertiary Health Care Facility in North India

Himani Dhingra, Manas Kalra, Leena Mendiratta, Hena Butta, Raman Sardana and Amita Mahajan

Introduction: Infections with multi drug resistant (MDR) organisms pose a major challenge in achieving optimal success in pediatric oncology patients. Aim: We aimed to study the evolving blood stream flora, its antibiotic resistance pattern and impact of a rigorous antibiotic stewardship programme at our center. Materials and Methods: A 10 year retrospective analysis was performed on suspected episodes of septicemia in pediatric oncology patients. Blood culture isolates, resistance patterns and clinical outcome of corresponding septic episodes were studied over two time periods- TP1 (2007-2013) and TP2 (2014-2018). Results: Of 1423 blood culture samples, 285 were positive. TP1 showed predominant growth of Gram negative bacteria (GNB-48.5%) and TP2 showed isolates that were mainly Gram positive cocci (GPC-50.3%) reflecting increased use of central lines. Coagulase negative Staphylococcus (CoNS) was the commonest GPC and E. coli was the most common GNB isolated in TP2. Cefaperazone sulbactum monotherapy was used as the first line antimicrobial for neutropenic fever in our unit in TP2 and it was observed that 72% of the GNB were sensitive to this drug. In the comparative analysis of TP2 vs TP1, it was observed that the GNB isolates showed increasing resistance to Carbapenems. Interestingly, a declining trend of resistance was observed with Chloramphenicol for both GNB/GPC. Flouroquinolone resistance has consistently been high over the two time periods. No in vitro resistance was identified to Glycopeptides and Colistin over TP1 and TP2. Mortality rates in children blood culture positivity remained the same across TP1 and TP2 (2.2 vs. 2.6%). Conclusion: Despite rising incidence of MDR bacteria, a rigorous antibiotic stewardship programme helps maintain good outcomes in pediatric oncology patients with sepsis. Early diagnosis, judicious use of antibiotics and de-escalation after initial stabilization may help. Innovative strategies to fight drug resistance are being evolved.