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LETTER TO EDITOR
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 28-29

Stool antibiogram as an antibiotic therapy determinant in haematological malignancy patients


1 Department of Microbiology, BLK Super Speciality Hospital, New Delhi, India
2 Department of Hemato-oncology and Bone Marrow Transplant, BLK Super Speciality Hospital, New Delhi, India

Date of Web Publication31-Mar-2017

Correspondence Address:
Purabi Barman
Department of Microbiology, BLK Super Speciality Hospital, Pusa Road, New Delhi - 110 005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2214-207X.203538

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How to cite this article:
Barman P, Chopra S, Sharma L, Choudhary D. Stool antibiogram as an antibiotic therapy determinant in haematological malignancy patients. J Patient Saf Infect Control 2016;4:28-9

How to cite this URL:
Barman P, Chopra S, Sharma L, Choudhary D. Stool antibiogram as an antibiotic therapy determinant in haematological malignancy patients. J Patient Saf Infect Control [serial online] 2016 [cited 2019 Nov 17];4:28-9. Available from: http://www.jpsiconline.com/text.asp?2016/4/1/28/203538



Dear Sir,

Bone marrow transplant has emerged as a treatment option in most of the patients with haematological malignancies. These patients become neutropenic during chemotherapy. As a result, they develop mucositis in the oral and gastrointestinal tracts. One of the common complications of mucositis is breach in the intestinal mucosal barrier which makes it susceptible to infections.[1] Neutropenia complicated with mucositis leads to translocation of gut flora into the bloodstream which can be a major cause of sepsis.

Ours is a tertiary care hospital with a leading bone marrow transplant unit. In January 2015, we experienced an increased number of bloodstream infections in this group. Most of these patients were infected with carbapenem-resistant Enterobacteriaceae (CRE). Initially, it was thought to be due to breach in infection-control protocols. Hence, all the protocols were further reinforced, and surveillance was conducted.

Meanwhile, one of the patients developed anal abscess and pus received for culture grew Klebsiella pneumoniae with similar antibiogram as his blood culture isolate. Stool culture was also sought and isolate with the same phenotypic characteristics was obtained. Stool culture was then concurrently sought for all the patients in this group. Since it is difficult to differentiate central line-associated bloodstream infection from mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), additional measures for compliance online handling were undertaken. Surveillance, however, did not lead to any concrete finding. Till date, we have screened stool samples of 61 patients of mixed nationality for CRE, of which 33 (54.09%) were CRE and 28 (45.90%) were carbapenem-sensitive Enterobacteriaceae. Amongst these 61 patients, 23 (37.7%) developed MBI-LCBI. A correlation between blood and stool culture isolates was noticed in 14 (60.87%) of MBI-LCBI patients. This finding highlights high-level antibiotic resistance in the community. Knowing the pattern of gut flora will help manage empiric antibiotics in these patients till the culture reports are available. It also emphasises the need to screen for CRE, at least in patients who are prone to mucositis. For better management of sepsis in patients on chemotherapy, screening the gut flora for their antibiotic susceptibility should be a part of their workup protocol.

Antibiotic resistance is no longer restricted to hospital setup now; in fact, it is prevalent in the community. Extended spectrum beta-lactamase production is also observed amongst community-acquired isolates in India.[2] High level of New Delhi metallo-beta-lactamase 1 was also reported from sewage water in Delhi.[3] The CRE carriage rate is higher in our study as compared to some previous studies.[4],[5] It may be due to the fact that the study group included long-term critical patients on multiple antibiotics during their treatment.[6] This incidence highlights that screening of gut flora for antibiogram can pave a path for successful antibiotic management in febrile neutropenic patients with mucositis complicated with sepsis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Stiff P. Mucositis associated with stem cell transplantation: Current status and innovative approaches to management. Bone Marrow Transplant 2001;27 Suppl 2:S3-11.  Back to cited text no. 1
    
2.
Mathur P, Kapil A, Das B, Dhawan B. Prevalence of extended spectrum beta lactamase producing gram negative bacteria in a tertiary care hospital. Indian J Med Res 2002;115:153-7.  Back to cited text no. 2
    
3.
Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: An environmental point prevalence study. Lancet Infect Dis 2011;11:355-62.  Back to cited text no. 3
    
4.
Perry JD, Naqvi SH, Mirza IA, Alizai SA, Hussain A, Ghirardi S, et al. Prevalence of faecal carriage of Enterobacteriaceae with NDM-1 carbapenemase at military hospitals in Pakistan, and evaluation of two chromogenic media. J Antimicrob Chemother 2011;66:2288-94.  Back to cited text no. 4
    
5.
Rai S, Das D, Niranjan DK, Singh NP, Kaur IR. Carriage prevalence of carbapenem-resistant Enterobacteriaceae in stool samples: A surveillance study. Australas Med J 2014;7:64-7.  Back to cited text no. 5
    
6.
Swaminathan M, Sharma S, Poliansky Blash S, Patel G, Banach DB, Phillips M, et al. Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 2013;34:809-17.  Back to cited text no. 6
    




 

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