Drug susceptibility pattern of gram negative bacterial isolates among hematological malignancy patients undergoing chemotherapy TikurAnbesa Specialized Hospital, Addis Ababa, Ethiopia

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Background: Gram negative bacterial infections are a major cause of morbidity and mortality in patients with hematological malignancies (HM) undergoing chemotherapy. The choice of empiric antimicrobial treatment is based on susceptibility pattern of locally isolated gram negative bacteria. Objective; to determine susceptibility pattern of gram negative bacterial (GNB) isolates and potential risk factors among hematological malignancy patients who undergo chemotherapy in Tikur Anbessa Specialized Hospital(TASH). Methods: A case control study was carried out for determining drug susceptibility pattern and associated risk factors for gram negative infections in patients with hematological malignancies in TASH Between March to August, 2016. A convenient sampling technique was used to select the study participants. Controls were patients admitted in the same ward during the same period but without gram negative infections. Equal number of cases and controls were included. Data was analyzed by using SPSS for windows version 21.0 and EPIINFO version 7.0. Differences between group proportions were assessed by chi-square X2 or McNemar’s test. Potential risk factors were analyzed by using univariate and multivariate analysis. For risk factor analysis p value and likelihood ratio were calculated. P<0.05 was considered significant. Results: Forty seven patients with gram negative infection (GNBI) and forty seven matched patients without gram negative infection (GNBI) were identified from TASH microbiology laboratory from March2016 to August 2016. Multivariate logistic regression analysis showed that four independent risk factors were significantly associated with GNBI in patients with HM. They were neutropenia (OR 12.2; 95% CI, 4.44-33.49; p<0.001), Durations of Neutropenia (OR, 28.42; 95% CI, 7.62-105.94 P=0.004), Length of Hospital Stay (OR 83; 95% CI, 5.11-1349.24; p<0.001), and Sever Neutropenia (OR 7.96; 95% CI, 2.46-52.82p=0.0004). The predominate isolate was maximally sensitive to carbapenems (92%) followed by aminoglycosides 80%. The multi-drug resistance rate of all GNB isolates in this study, K.pneumonia (37%) was predominating followed by E.coli 3(26%).Except cefepem all third generations’ cephalosporin drugs had low sensitivity. Conclusions: Our findings suggest that gram negative infections in patients with hematological malignancies strictly correlate with severity of neutropenia and extended hospital stays. The results of this study initiate the hematology unit for the development of effective interventions to minimize the impact of GNBI in TASH. Continuous surveillance of the bacterial etiologies and its antimicrobial susceptibility pattern is crucial.



Gram negative bacteria; chemotherapy, Risk factors