Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2022 / BACKGROUND
Febrile neutropenia is a medical emergency that complicates the clinical course and
treatment of both hematological and solid malignancies, potentially worsening the
overall outcome and increasing the financial burden. The epidemiology of pathogens
is varied, and determines the selection of empiric antibiotic therapy for febrile
neutropenia. Empirically piperacillin/tazobactam plus amikacin has been
recommended as the most suitable antibiotic for management of febrile neutropenia.
There is a lack of local studies to provide advice for antibiotic choice in our setting.
OBJECTIVE
To identify causative organisms of infection and antibiotic susceptibility patterns in
childhood cancer patients with chemotherapy related febrile neutropenia in
Pietersburg Hospital Oncology Ward Limpopo Province.
METHODS
This is a retrospective cross-sectional study that reviewed all the febrile neutropenic
episodes in children with cancer and with a positive blood culture during the febrile
neutropenia episode. Data collected included patient demographics (date of birth,
sex, date of diagnosis) diagnosis, organisms cultured and the antibiotic sensitivity
profile.
RESULTS
There were 152 records of positive blood cultures identified of 348 episodes of
febrile neutropenia for 413 patients. The median age of study population is 6years
(mean age of 6.8years; range 3 to 11years) with male predominance at (61.2%). The
most common cancer diagnosis was Acute Lymphoblastic Leukemia (ALL) (33.6%)
followed by Nephroblastoma (15.8%), Acute myeloid leukemia (11.2%), Non-
Hodgkin’s lymphoma (9.9%), Hodgkin’s lymphoma (5.9%) and other cancers
(15.3%). The majority of causative organisms were gram-positive bacteria (45%)
followed by gram-negative bacteria (32.4%) and fungi (6.1%). Gram-positive
organisms were statistically significant pathogens causing bacteraemia more often in
neutropenic patients than gram-negative organisms with a p value=0.016. The
majority (n=102; 67.10%) were sensitive organisms with the minority being multidrug
resistant organisms (n=23; 15.1%) and 17.8% were contaminants n=27. The most
common gram-positive pathogens were Coagulase negative staphylococcus n=37;
(21.6%). The most common multidrug resistant organisms were Klebsiella
pneumoniae CRE (10.7 %;), followed by Enterococcus faecium VRE (1.9%),
Klebsiella oxytoca CRE (1.3%), Enterococcus faecalis VRE (0.6%), and
Staphylococcus aureus MRSA (0.6%). No multidrug resistant fungal organisms were
cultured. The majority of organisms were sensitive to the first line empiric therapy
piperacillin/tazobactam plus Amikacin (67.10%). Thirty patients died during these
febrile neutropenic episodes and case fatality rate was 8.6%.
CONCLUSION
This study confirmed that the causative bacteria of febrile neutropenia in this study
were susceptible to the first line empiric therapy piperacillin/tazobactam plus
amikacin, and this regimen is therefore appropriate for this paediatric oncology unit.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ul/oai:ulspace.ul.ac.za:10386/4172 |
| Date | January 2022 |
| Creators | Mothiba, Nomsa Edith |
| Contributors | Netshituni, V. B., Kruger, M. |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | xiii, 39 leaves |
| Relation |
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