American Journal of Medicine and Medical Sciences

p-ISSN: 2165-901X    e-ISSN: 2165-9036

2018;  8(9): 246-249

doi:10.5923/j.ajmms.20180809.06

 

The Agents of Sepsis in Patients with Diseases of the Blood and the Analysis of Their Sensitivity to Antibiotic Therapy

Karimov Khamid Yakubovich, Shevchenko Olga Igorevna

Scientific Research Institute of Hematology and Blood Transfusion, Uzbekistan

Correspondence to: Shevchenko Olga Igorevna, Scientific Research Institute of Hematology and Blood Transfusion, Uzbekistan.

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Copyright © 2018 The Author(s). Published by Scientific & Academic Publishing.

This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract

The structure and antibiotic sensitivity of 136 pathogens, isolated from the blood of 302 patients with hematologic malignancies and sepsis, hospitalized at different departments, were studied. Gram-positive was identified in 79% of cases and was introduced strains Staphylococcus epidermidis (25%) and Staphylococcus aureus (48%). Isolated microorganisms were most sensitive to cefoperazone / sulbactam (74-88%), cefepime (58-71%) and amikacin (89%).

Keywords: Infection, Bacteremia, Sepsis, Hematological malignancies, Sensitive

Cite this paper: Karimov Khamid Yakubovich, Shevchenko Olga Igorevna, The Agents of Sepsis in Patients with Diseases of the Blood and the Analysis of Their Sensitivity to Antibiotic Therapy, American Journal of Medicine and Medical Sciences, Vol. 8 No. 9, 2018, pp. 246-249. doi: 10.5923/j.ajmms.20180809.06.

1. Introduction

Antimicrobial therapy in immunocompromised patients is a problem in countries around the world. The frequency of infectious complications in hemoblastoses during neutropenia is 75-96%, mortality from infection complications (IC) reaches 10-12% [1, 2]. The basic principle of treatment of infectious complications in cancer patients – immediate prescribing of antibiotic therapy in case of fever and/or the first signs of infection without waiting for documentary evidence of bacterial laboratory [3]. For prescribing adequate antibiotic therapy of IC in patients with hematological malignancies during neutropenia, first of all, you must know the structure of pathogens of these infections, and to carry out regular monitoring of the dynamics of resistance to antibiotics.
According to foreign and Russian authors, in 90 years of the twentieth century, there was an increase in the proportion of Gram-positive bacteria in the structure IC patients with hematological malignancies, the identification of which has increased to 60-70%, compared to the 70s, when the predominant infection caused by gram-negative bacteria, which accounted for 60-70% of the proportion of cases [4, 5]. Currently there is a tendency to re-increasing role in the etiology of Gram-negative pathogens of IO [6].
On structure of the pathogens in immunocompromised patients can affect a variety of factors. The most significant of them - genetic, climatic, ecological. Furthermore, the role played the presence of nosocomial infection in hospitals where often identified by antibiotic-resistant strains of microorganisms. Microbial resistance isolated of neutropenic patients, and their spectrum can vary in individual countries and in some clinics. In this regard, it is important to study the structure of the etiological agents of IC and their sensitivity to antibiotics in modern conditions.

2. The Purpose of Research

Analyze the structure of sepsis pathogens in patients with neoplastic diseases of the blood and to identify the most effective antibacterial agents active against selected pathogens.

3. Main Body

3.1. Materials and Methods

The study protocol included 302 patients with various tumor diseases of the blood, who were hospitalized at the Institute of Hematology and Blood Transfusion in the period from 2009 to 2015. Patients were divided into four groups depending on the age and nosological. The 1st group included 85 patients with acute leukemia (AL), were treated in the adult department (median age was 32,8 ± 4,6 y., 79 men and 29 women). The 2nd group consisted of 156 patients with AL who were treated in the pediatric department (median age was 6,05 ± 1,2 y., 98 boys and 58 girls). The 3rd group consisted of 38 patients with aplastic anemia (AA) (the median age was 23.9 ± 3,1y., 26 men and 12 women). The 4th group included 23 patients with chronic forms of leukemia: 11 patients with chronic myeloid leukemia (CML), 7 patients with chronic lymphocytic leukemia (CLL) and 5 patients with multiple myeloma (MM) (median age was 38,5 ± 4,2 y., 18 men and 5 women).
The material of the study was blood obtained from patients with symptoms of sepsis. Blood was taken for microbiological examination of patients from a peripheral vein or venous catheter in the event of fever above 38°C until the prescribing of antibacterial therapy. Planting was carried out in a ready two-phase medium "HiCombi" (HiMedia, India). Cultures were incubated for 10 days at a temperature of 35-37°C. Identification of microorganisms was carried out by routine methods adopted in the bacteriological laboratory.
Determination of the sensitivity of isolated strains of microorganisms to antibiotics was carried with a disk diffusion method using ready-standardized discs by foreign production and Mueller-Hinton medium (HiMedia, India). The essence of this method is to use a disc containing a concentration gradient of antimicrobial agents. Diffusion of the antibiotic in the agar results in the formation of microbial growth inhibition zone around the disc. After incubation of the plates in the incubator at 35-37°C for 24 hours, taken into account the result of largest diameter of the inhibition zone around the disc, measured in millimeters. On the basis of the diameters of the microorganism growth inhibitory zone around the disc with antibiotics tested strains were classified as sensitive, moderately resistant and resistant.
Statistical processing and data analysis was performed using statistical software package "Microsoft Excel 2010" and «OpenEpi 2009, version 2.3».

3.2. Results

The blood sample 302 has been studied by us for 6 years, in which the exciters 136 (45%) were identified. Bacteremia in the 1st group of patients was identified in 41 of 85 cases (48%). In group 2, a positive result was obtained in 68 of 156 cases, accounting for 44%. In the third group of patients with bacteremia was identified in 25 of 38 cases (66%). In the 4th group of patients with positive blood culture was identified in 2 of 21 cases (9%). Thus, in all groups, except for the AA patients, often fail to identify the causative agent of sepsis, which may be associated with other possible etiological causes of fever in patients, such as joining a fungal or viral infection.
In the analysis of microorganisms isolated from the blood of patients it revealed a significant prevalence of gram-positive bacteremia flora in the etiology (108 cases out of 136, or 79%) (Table 1). Gram-negative organisms were detected in 28 of the 136 cases (21%). In the 1st group of patients gram-positive pathogens was identified in 24 of 41 cases (58.5%), in the 2nd group - 60 out of 68 cases (88%) in the 3rd group – 22 out of 25 cases (88%) and 4th group – 2 out of 2 (100%).
Table 1. The agents of bacteremia in patients with blood diseases
     
Species composition of strains of microorganisms isolated from the blood of patients with the four groups is presented in Table 2. As can be seen from table 2, among gram-positive bacteria Staphylococcus bacteria family met significantly more frequently, the number of which amounted to 99 out of 136 cases (73%). The structure of the gram-positive microorganisms was distributed as follows: Staphylococcus epidermidis was identified in 25% of cases, Staphylococcus aureus - 48%, Enterococcus - 3%, Streptococcus haemolyticus – 4%. The gram-negative flora was represented primarily by microorganisms Enterobacteriaceae family: Enterobacter spp. (14%), Klepsiella pneumoniae (2%), Pseudomonas aeroginosa (2%), Escherichia coli (1,3%) and Proteus vulgaris (0,7%).
Table 2. The species composition of microorganisms isolated from the blood
     
In a study have been identified of differences in types of pathogens. Thus, in patients with AL in adult department often identified Staphylococcus epidermidis, which detection was 27% (11 of 41 cases). The second highest prevalence is Staphylococcus aureus, which was identificated in 19.4% (8 out of 41 cases). In a few cases plated Enterococcus (10%) and Streptococcus haemolyticus (2,4%).
It should be noted that patients in the pediatric depertment AL Staphylococcus aureus identified most 2,3 times relative Staphylococcus epidermidis (57% vs. 25%). So, Staphylococcus aureus in these patients was detected in 39, and Staphylococcus epidermidis - 17 out of 68 cases. In 4 cases (6%) identified Streptococcus haemolyticus.
In patients with AA of all identified microorganisms, significantly more often determined by Staphylococcus aureus (72%). In 16% of cases was Staphylococcus epidermidis.
In patients with chronic forms of leukemia in all 2 cases (100%) identified Staphylococcus epidermidis.
Thus, we have been identified differences on certain types of bacteria in various departments, but at the same time, the differences have not been recorded by major groups of pathogens. Differences were obtained identifying the number of cases in groups of Staphylococcus epidermidis and Staphylococcus aureus. Patients of the 1st and 4th groups often identified Staphylococcus epidermidis. It should be noted that in recent years there has been a significant increase in the share of this type of bacteria that may correspond to the period of wide introduction in hematology clinic percutaneous central venous catheterization. This fact gives reason to assume that the introduction of a central catheter to a certain extent affect the etiology of bacteremia, as noted by other researchers [7]. Patients in 2nd and 3rd groups in the blood often determined by Staphylococcus aureus.
Summary of sensitivity of Staphylococcus epidermidis are shown in table 3. The highest activity was observed in cefoperazone / sulbactam (88%) and cefepime (71%). If we consider separately the group of patients in the groups where the pathogen isolated in a large number of cases (1st and 4th groups) also showed the highest activity of cefoperazone / sulbactam and cefepime. The high activity in patients with AL showed ceftriaxone in the adult department (73%). Meronem showed average total activity (50%) and was the most active against strains isolated from group 1 patients (64%).
Table 3. Sensitivity to antibiotics to Staphylococcus epidermidis
     
The overall sensitivity of Staphylococcus aureus was the highest for cefoperazone / subaktam (74%) and amikacin (78%) (Table 4). In 62% of cases their activity showed ceftazidime. Given that the more Staphylococcus aureus was identified in patients with the 2nd and 3rd groups, identify patterns and finds its confirmation in these groups separately. So in the 2nd group the sensitivity of Staphylococcus aureus to amikacin was 82%, in the 3rd group - 94%, sensitivity to cefoperazone / sulbactam in the 2nd group was 82%, in the 3rd group - 94%. Sensitivity to meronem was 55% and was highest in patients of group 1 (63%).
Table 4. Sensitivity to antibiotics to Staphylococcus aureus
     
Despite the fact that gram-negative flora have been identified in a few cases (21%), contact has been detected maximum total sensitivity to amikacin (89%), which is supported in each separate group (1st group - 86%, 2nd and 3rd group - 100%). Sensitivity to antibiotics of the cephalosporin class varied from 37-58%. Sensitivity to meronem was low and amounted to 26%.

4. Conclusions

Studies have once again confirmed the presence of a wide range of pathogens, responsible for the development of IC in patients with hematological malignancies. In structure of the pathogens of sepsis in patients with systemic blood diseases recorded prevalence of gram-positive flora over the gram-negative. Gram-positive flora was represented by microorganisms of Staphylococcus family. Legitimate differences were revealed detectable microflora depending on the hospital where patients stayed with different nosologies. In patients with acute and chronic forms of leukemia in the adult branch most often determined by Staphylococcus epidermidis, while the AL patients in the pediatric department, and in patients with AA, the most frequently identified Staphylococcus aureus.
Dedicated bacteria, which were represented by various strains of Staphylococcus, showed similar sensitivity to antibiotics. Of the most active cephalosporins were cefoperazone / sulbactam and cefepime of aminoglycosides - amikacin. Carbapenem meronem showed in study low activity against selected strains of microorganisms, especially its high-resistance has been observed with Gram-negative pathogens. This fact must be considered when conducting empirical antibiotic therapy.
The data obtained allow us to recommend the use of combinations of cefoperazone / sulbactam + amikacin and cefepime + amikacin in the mode of the first phase of antibiotic therapy in case of IC in patients with blood diseases.

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