Surveillance of healthcare-associated infections in adult patients with leukemia in Kuwait cancer control center

ABSTRACT

To study the incidence, types and microbial etiology of healthcare-associated infections affecting adult patients with leukemia and the antimicrobial susceptibility of Gram-negative bacteria to ciprofloxacin. Prospective study. Kuwait Cancer Control Center [KCCC], Kuwait. All adult patients suffering from different types of leukemia, managed in the Hematology-Oncology unit over a period of 15 months [January 2006 - March 2007]. Prospective surveillance of healthcare-associated infections. Overall incidence density rate of healthcare-associated infections was 13.4/1000 patient days. Patients suffering from acute myeloid leukemia [AML] had the highest infection rate [16.2/1000 patient days]. The rates were significantly higher in acute types of leukemia than chronic ones [p = 0.001]. Infections develop significantly more in female patients [p < 0.001]. The most frequently reported infections were blood stream infections [BSI, 46.9%] followed by skin and soft tissue infections [SST, 25.7%]. Eighty-three percent of BSI was central line-associated. Gram-negative bacteria, Gram-positive bacteria and fungi were isolated from 69.9, 18.6 and 4.4% of all infections respectively. Escherichia coli [E. coli] were isolated from 35.2% of all microbiologically-documented infections followed by Pseudomonas aeruginosa [15.2%]. Majority of the isolated Gram-negative bacteria were ciprofloxacin resistant including E. coli, with 97.3% resistance to ciprofloxacin. Majority of the infections [80.5%] were associated with a neutrophil count of < 500 cell/mm[3] in patients receiving ciprofloxacinprophylaxis. Infections remain a major complication in adults with acute leukemia. Continuous monitoring of the rate of Gram-negative bacteremia is recommended for timely detection of the loss of efficacy of fluoroquinolone prophylaxis