Pattern of Blood Stream Bacterial Infection in Acute Leukaemic Patients with Febrile Neutropenia during Chemotherapy

Introduction: Febrile neutropenia due to blood stream infections are associated with increased mortality and morbidity in immunocompromised acute leukaemia (AL) patients. This study analysed the pattern of blood stream bacterial infection in AL patients with febrile neutropenia during chemotherapy cycle. Objective: To study the pattern of blood stream bacterial infection in acute leukaemic patients with febrile neutropenia during chemotherapy cycle. Materials and method: This cross-sectional observational study was conducted in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2021 to June 2022, following ethical clearance. Total 70 admitted AL patients with febrile neutropenia during chemotherapy were included. After getting written informed consent, a detailed history, thorough clinical examination and necessary investigations were carried out in each patient. Blood culture was analysed by BACTEC 9240 system and antibiotic susceptibility testing was performed by disc diffusion method. Data were collected in separated case record form and analysed by SPSS-24.0. Data analysis and presentation was made by statistical software SPSS 24 windows version 10. Statistical analysis was done by Chi-square test, Student’s t-test. Result: Mean age of study patients was 34.14±16.93 (SD) years with male preponderance (57.1%). Maximum study patients had acute myeloid leukaemia (51.4%), and rest had acute lymphocytic leukaemia (44.3%) and mixed type (4.3%). Along with fever, maximum patients had respiratory symptoms (48.6%) and gastro-intestinal symptoms (28.6%). Thirteen patients (18.6%) had positive bacterial growth, wherein Klebsiella (53.8%) was the most common organism, followed by Acinetobacter (23.1%), E. coli (7.7%), Achromobacter (7.7%), and Staphylococcus (7.7%). Colistin was the most sensitive antibiotic to gram negative bacteria, while ceftriaxone was the most resistant antibiotic. Conclusion: Gram negative bacteria, especially Klebsiella was the most common organism in culture positive AL patients with febrile neutropenia during chemotherapy cycle. While Colistin was found to be the most sensitive antibiotic for Gram negative organisms.