Carbapenem-resistant Enterobacteriaceae : A serious concern in cancer patients

Introduction. Gram-negative bacteria, including Enterobacteriaceae, are an important cause of infections in cancer patients. Members of Enterobacteriaceae are commonly isolated from bloodstream infections, surgical site infections, urinary tract infections, and lower respiratory tract infections. There has been an increase in the isolation of gram-negative MDRO’s over the years with ESBL’s and for the last few years with carbapenem-resistant Enterobacteriaceae (CRE). CRE’s have become a serious threat to cancer patients.

Material & Methods. A total of 61331 clinical samples from 19015 patients were received in the Dept of Microbiology, Tata Memorial Center, Mumbai, India during January 2018 to May 2019. All the samples were processed as per routine microbiological procedures and antimicrobial susceptibility testing was performed as per CLSI guidelines.

Results. Blood was the commonest sample received followed by urine, respiratory tract samples, surgical site samples and sterile body fluids. E. coli was the commonest microorganism isolated followed by Klebsiella pneumoniae, P. aeruginosa, S. aureus, Acinetobacter sp., Enterobacter sp. and Enterococci. Colistin was the most susceptible antibiotic for gram negative organisms followed by tigecycline, aminoglycosides, cefoperazone-sulbactam and piperacillin-tazobactam. Overall 77.8% CRE’s were detected whereas it was 81.8% in LRTI, followed by 82.5% in UTI, 79.1% in BSI and 75% in SSI.

Conclusion. The increasing prevalence of CRE infections represents a major threat to cancer patients. With the high mortality of CRE infections and increasing resistance to available antibiotics, it is urgent for the medical community to develop new and effective therapeutic strategies. Robust anti-microbial stewardship is the need of the hour.