Prevalence and Determinants of Antimicrobials Resistance of Pathogens Among Cancer Patients in Intensive Care Units

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Abstract Background: Infections caused by multidrug-resistant organisms (MDRO) are a global increasing threat among critically ill patients, especially those with underlying malignancy. We aimed to assess the prevalence, susceptibility patterns of MDRO among cancer patients in intensive care units (ICU) and their predictors.Methods: Over 4 years, we retrospectively reviewed medical records of 497 malignancy patients in ICU of a tertiary hospital in Egypt. Data for various factors like demographic characters, comorbidities, causative pathogen, and antimicrobial resistance (AMR) were collected and analyzed using univariate analysis. Logistic multivariate regression analysis was used to develop a clinical prediction model to estimate the probability of developing MDRO among this population. Results: A total of 748 isolates were obtained from 1249 collected clinical specimens. Gram-negative bacterial pathogens detected were 459 (61.4%) of all isolates, while 75 (10%) only were Gram-positive and 214 (28.6%) were fungal pathogens. The most frequent isolate was Klebsiella pneumoniae (n= 183), of which 107 were carbapenem resistant (CR) and 62 were extended spectrum beta lactamase (ESBL) strains. This was followed by Escherichia coli (n= 136), of which 17 were CR and 100 were ESBL strains while 3 were quinolone resistant. Furthermore, Acinetobacter baumannii (n= 67), of which 63 were CR. Overall susceptibility of gram-negative pathogens to antibiotics was recorded highest among colistin (97.3%). The prevalence of methicillin- resistant Staphylococcus aureus (MRSA) and Enterococcus species among Gram-Positive bacteria were 54.6% and 33.3% respectively, with no resistance reported to vancomycin, teicoplanin or linezolid. Among MDRO acquisition predictors were neutropenia, recent antibiotics use and receiving chemotherapy. Neutropenia had the highest odds ratio (O.R: 2.3, C.I: 1.28- 4.09) followed by recent antibiotics use (O.R: 1.8, C.I: 1.22- 2.59).Conclusion: Gram-Negative Bacilli were the most frequent reported MDRO, with resistance to higher generation cephalosporins and even carbapenems, limiting antibiotic treatment options to older class of antibiotics as colistin with potential side effects as nephrotoxicity. Estimating AMR probability using the prediction model of risk factors as neutropenia and previous antibiotics use, maybe functional in rapid identification of higher risk patients.

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