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We intend to review the aetiology of BSI and check the effectiveness of the antibiotics used in ESHT in cancer patients.

This retrospective study was conducted at ESHT from January 2006 to December 2015. Demographic and laboratory data were collected from the Pathology information system.

A total of 640 episodes of BSI occurred in 297 patients (159 male). Of the 297 patients, 239 had haematology malignancies while 54 had solid organ tumour. Four patients had both. The neutrophil count was <1 cells/10⁹ in 383 episodes and majority of BSI occurred in this group. A total of 802 organisms (477 and 325 organisms from neutropenic and non-neutropenic respectively) were isolated. Of 802, 406 Gram positive and 386 Gram negative organisms were isolated. Seven Mycobacterium species and three Candida species were isolated. Most common organisms in neutropenic patients were Coagulase negative Staphylococcus (CoNS) (22%), Klebsiella species (14%), Escherichia coli (13%), Streptococcus species (10%), Pseudomonas species (10%), Enterococcus species (8%) and Staphylococcus aureus (4%). In non-neutropenic patients, CoNS (29%), Escherichia coli (11%), Pseudomonas species (8%), Streptococcus species (7%), and Klebsiella species (5%) were isolated. Figure1 summarises the most common organisms causing BSI. Twelve Glycopeptide resistant Enterococci were isolated. Four Methicillin resistant Staphylococcus aureus were isolated. In addition, 15 Extended Spectrum Beta-lactamase producing Gram negative bacilli were isolated. Among Gram negative organisms, more than 91% isolates were sensitive to piperacillin/tazobactam, ceftazidime and ciprofloxacin and higher sensitivity rates (>96%) were recorded in gentamicin and meropenem. Table1

summarises the effectiveness of antibiotics used.

Table1. The sensitivity of antibiotic regimens used

This study highlights an on-going trend towards Gram positive organisms causing BSI in cancer patients. The antimicrobial regimens used in ESHT are highly effective against commonly isolated organisms. An early diagnosis and timely administration of appropriate antibiotics are imperative in managing BSI. The identification and the antimicrobial susceptibility of the microorganisms causing BSI in cancer patients remain important to develop antimicrobial treatment strategies, and to prevent the spread of antimicrobial resistance.