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Abstract

Introduction. The standard intensive chemotherapy in acute leukemia patients will cause severe neutropenia and infection (febrile neutropenia) with high fatality rate. The availability of accurate data on causative pathogens is essential to the appropriate selection of empirical therapy and usually obtained from bacterial surveillance. This study was intended to evaluate bacterial pathogens found on surveillance and during febrile neutropenia in acute leukemia patients undergoing chemotherapy at Cipto Mangunkusumo Hospital and to provide information for antimicrobial policy in the hospital. Methods. A retrospective study from data of bacterial surveillance of acute leukemia patients undergoing chemotherapy during 2008-2010 in isolation room for acute leukemia patients at 8th floor of ‘Gedung A’ Cipto Mangunkusumo Hospital, Jakarta. The isolates for surveillance data were obtained from cultures from feces culture, nasal and throat swab, preputium swab and other sites (urine, sputum, skin infection - as indicated) from acute leukemia patients before and during intensive chemotherapy. Blood sample for blood culture was collected from central venous catheter and peripheral veins using Bactec during febrile neutropenia, and the other specimens (swab, urine, feces cultures) were collected according to the standard laboratory procedure. All specimens were collected by nurses in isolation room and bacterial cultures were performed at microbiology division of Clinical Pathology Department Cipto Mangunkusumo Hospital. Results. There were 1,127 isolates of acute leukemia patients (acute myeloid leukemia - AML or acute lymphocytic leukemia - ALL) that could be analyzed. Gram positive bacteria was significantly higher than gram negative bacteria from all cultures, from respiratory tract (514 out of 675 isolates; 76.1%) and blood culture (Staphylococcus epidermidis and Streptococcus anhemolyticus – 81 out of 103 isolates; 78.7%). Regarding bacterial surveillance in colon, only 8 out of 45 E. coli isolates from feces can be analyzed for sensitivity to ciprofloxacin/cotrimoxazole and the other 37 isolates were sensitive to other antimicrobials that not commonly used for gut decontamination in acute leukemia. The sensitivity pattern of the other isolates could not be analyzed to the antibiotics recommended for the management of febrile neutropenia due to wide range of antibiotics tested. Conclusion. From 1,127 isolates found among acute leukemia patients undergoing intensive chemotherapy at Cipto Mangunkusumo Hospital, it was found that gram positive was the most common bacteria found on upper respiratory tract from bacterial surveillance and from blood culture during febrile neutropenia

References

1. Percival M. E, Estey E. Emerging treatments in acute myeloid leukemia: current standards and unmet challenges. Clin Adv in Hematol Oncol. 2017;15:8:632-42. 2. Rowe J. C, Tallman M. S. How I treat acute myeloid leukemia. Blood. 2010;116(17)3147–56. 3. DiNardio C. D, Wei A. H. How I treat acute myeloid leukemia in the era of new drugs. Blood. 2020;135(2):85–96. 4. Gustinetti G, Mikulska M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence. 2016;7(3):280–97. 5. Kochanek M, Schalk E, von Bergwelt-Baildon M, Beutel G, Buchheid D, Hentrich M, et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2019;98:1051–69. 6. Vahedian-Ardakani HA, Moghimi M, Shayestehpour M, Doosti M, Amid N. Bacterial spectrum and antimicrobial resistance pattern in cancer patients with febrile neutropenia. Asian Pac J Cancer Prev. 2019;20:5:1471-4. 7. Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016:27(suppl 5): v111–8. 8. Huang CC, Wu CJ, Wang LR, Lee HC, Chang CM, Lee NY, Chen TY, Ko WC. Antimicrobial susceptibility of bacteremic isolates from cancer patients with or without neutropenia at a medical center in southern Taiwan. J Microbiol Immunol Infect. 2011;44(5):376-81 9. Sukrisman L. Four-year report of acute leukemia patients undergoing intensive chemotherapy in 7th floor IRNA A Cipto Mangunkusumo Hospital Jakarta 2003-2008 [not published]. 10. Standard procedure of acute leukemia patient undergoing intensive chemotherapy in Cipto Mangunkusumo Jakarta, Indonesia; 2018. 11. Trecarichi EM, Tumbarello M. Antimicrobial-resistant gramnegative bacteria in febrile neutropenic patients with cancer: current epidemiology and clinical impact. Curr Opin Infect Dis. 2014;27:200–10. 12. Alison G, Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis. 2011;52(4):e56–93. 13. Departemen Ilmu Penyakit Dalam RSCM. Pedoman penggunaan antibiotik (PPAB) Departemen Ilmu Penyakit Dalam, RSUPN Dr. Cipto Mangunkusumo. Jakarta: Departemen Ilmu Penyakit Dalam RSCM; 2017. hal.1-33.

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