Isolation of Pathogenic Bacteria and Their Antibiotic Sensitivity Profiles in Hospitalized Febrile Neutropenic Children with Acute Lymphoblastic Leukaemia

Background: Acute lymphoblastic leukemia (ALL) is the commonest malignancies in childhood. Common obstacle in the treatment of ALL is febrile neutropenia and its complications. Objectives: To identify bacteria causing infection, their isolation rate and antibacterial sensitivity pattern in hospitalized febrile neutropenic children with ALL in different cycle of chemotherapy. Methodology: This observational study conducted in 2014 - 2015 in the department of paediatric haematology and oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Bangladesh. Sixty febrile neutropenic episodes from 52 diagnosed cases of ALL aged 0 to18 years were included. Complete blood count, blood culture, urine microscopy and culture, serum alanine aminotransferase, serum creatinine were done in every patient. X-ray chest, stool microscopy and culture, pus, wound, throat and aural swab for culture & sensitivity were done in selective patient. Results: Bacterial infection was confirmed by culture in 15 (25%) episodes from 60 febrile neutropenic episodes. Fifteen (25%) organisms were isolated from the study subjects from sample of blood (60%), pus (13.3%), aural swab (13.3%), wound swab (6.7%) and throat swab (6.7%) respectively. All isolates were gram negative. The organism isolated were Klebsiella spp. 5 (33.31%), E. coli 4 (26.7%), Acinetobacter 3 (20%), Pseudomonas 2 (13.3%) and only one (6.7%) Enterobacter species. All the isolates of the Klebsiella spp., E. coli and Acinetobacter spp. were resistant to amoxicillin. All isolated E. coli were resistant to cotrimoxazole, ceftazidime, ceftriaxone, cefotaxime and ciprofloxacin, Acinetobacter spp. Isolated were 100% sensitive to imipenem, colistin sulphate & piperacillin-tazobactam and resistant to cotrimoxazole and cephradine. All Pseudomonas spp. showed 100% sensitivity to imipenem, amikacin, ciprofloxacin & colistin and resistances to ceftazidime. Conclusion: The species of Klebsiella were the predominant causative bacterial agent followed by Escherichia coli, Acinetobacter spp, pseudomonas spp. and Enterobacter spp. They showed resistance to commonly prescribed antibiotics ceftazidime, gentamicin, ceftriaxone & ciprofloxacin and sensitive to imipenem, colistin-sulphate & piperacillin-tazobactam.