The Prevalence of Bacteraemia in Neutropenic Paediatric Cancer Patients on Chemotherapy at the University Teaching Hospital

Title: The Prevalence of Bacteraemia in Neutropenic Paediatric Cancer Patients on
Chemotherapy at the University Teaching Hospital in Lusaka, Zambia.
Background: Bacteraemia in neutropenic paediatric cancer patients can lead to high
morbidity and mortality if not treated properly. The prevalence of bacteraemia and
antibiotic sensitivities are liable to change according to region and time. The study
investigated the pattern of bacteraemia and antibiotic sensitivity patterns in neutropenic
paediatric cancer patients at the University Teaching Hospital in Lusaka, Zambia.
Methods: A descriptive and analytical cross-sectional study was done at the Paediatric
Oncology Ward of the University Teaching Hospital in Lusaka, Zambia. We evaluated
100 neutropenic episodes in 53 paediatric cancer patients with suspected neutropenic
sepsis. These were enrolled following a consent procedure. Information was obtained
from an interviewer administered questionnaire and the attending physician’s case notes.
One millilitre of blood was then drawn for blood culture and sensitivity testing, and
another one millilitre for full blood count. Information was entered using Epi info
version 7 and analysed using SPSS version 2.1 for windows.
Results: The prevalence of bacteraemia in neutropenic paediatric cancer patients in this
study was five per cent (5%). Four patients with positive blood cultures were in a critical
condition (p value of 0.02). Gram negative organisms were isolated more often than
gram positive organisms (80 per cent versus 20 per cent). Gram negative bacterial
isolates were Enterobacter agglomerans (20%), Escherichia coli (20%), Pseudomonas
aeruginosa (20%), and Klebsiella pneumoniae (20%). One gram positive bacterium
[v]
isolated was Staphylococcus aureus (20%). All gram negative isolates were from inpatients
while the gram positive bacterium isolated was from an outpatient. In antibiotic
sensitivity tests, two of four isolates (50%) of gram negative bacteria were sensitive to
ciprofloxacin, two of four isolates (50%) were sensitive to gentamicin, and zero of four
isolates were sensitive to cefotaxime. Escherichia coli isolate was resistant to
ciprofloxacin. In the case of gram positive bacterium, Staphylococcus aureus was
sensitive to chloramphenicol and clindamycin but resistant to penicillin and oxacillin.
Conclusion: Bacteraemia in paediatric cancer patients at the UTH in Lusaka mostly
affects a young population of children (median age 6 years) in advanced stage of their
disease. Commonest malignancies involved are leukaemias and lymphomas. Most
patients are not infected with HIV. The major causative organisms of bacteraemia are
gram negatives (80%) with high antimicrobial resistance to the commonly used
antibiotics on the oncology ward. The choice of antibiotic in treating neutropenic
paediatric cancer patients with suspected bacteraemia needs to take into account the
prevalence of gram negative bacteraemia among in patients and antibiotic resistance of
gram negative and gram positive bacteria.