Hossam M Ashour1, Amany el-Sharif. 1. Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Kasr El-Aini St, Cairo, Egypt 11562. hossamking@mailcity.com
Abstract
PURPOSE: Cancer patients are particularly susceptible to nosocomial infections because of their compromised immune system, and because of the nature of treatment practices they experience. Recently, a shift of the microbial spectrum of cancer patients from gram-negative to gram-positive has been demonstrated. This study analyzed the distribution and the antimicrobial resistance of gram-positive bacteria isolated from cancer patients in Egypt. PATIENTS AND METHODS: We examined the microbial spectrum of gram-positive bacteria in patients with hematologic malignancies and solid tumors. In addition, we also studied the antimicrobial resistance of pathogens accounting for the majority of gram-positive infections in these cancer patients. RESULTS: Most of gram-positive isolates from urinary tract (100%), respiratory tract (89.7%), and bloodstream infections (BSIs; 65.5%) were obtained from leukemic patients. All gram-positive isolates from skin infections were isolated from solid-tumor patients. In both leukemic and solid-tumor patients, gram-positive bacteria causing nosocomial BSI were mainly Coagulase-negative staphylococcus (CNS) and S. aureus, whereas gram-positive bacteria causing nosocomial RTI were mainly alpha-hemolytic streptococci and CNS. Gram-positive bacteria were not isolated from GI tract infections. S. aureus, CNS, and alpha-hemolytic streptococci demonstrated methicillin resistance (81.5%, 92.3%, and 90% resistance, respectively). S. aureus and CNS were susceptible to linezolid (15.4% and 0% resistance, respectively), and vancomycin (15.5% and 11% resistance, respectively). CONCLUSION: This is the first study to report the emergence of vancomycin- and linezolid-resistant S. aureus in Egypt. Newer generation quinolones (moxifloxacin and gatifloxacin) were more active than older quinolones (ciprofloxacin and ofloxacin) against S. aureus and CNS, suggesting the use of newer generation quinolones in the prophylaxis of cancer patients.
PURPOSE:Cancerpatients are particularly susceptible to nosocomial infections because of their compromised immune system, and because of the nature of treatment practices they experience. Recently, a shift of the microbial spectrum of cancerpatients from gram-negative to gram-positive has been demonstrated. This study analyzed the distribution and the antimicrobial resistance of gram-positive bacteria isolated from cancerpatients in Egypt. PATIENTS AND METHODS: We examined the microbial spectrum of gram-positive bacteria in patients with hematologic malignancies and solid tumors. In addition, we also studied the antimicrobial resistance of pathogens accounting for the majority of gram-positive infections in these cancerpatients. RESULTS: Most of gram-positive isolates from urinary tract (100%), respiratory tract (89.7%), and bloodstream infections (BSIs; 65.5%) were obtained from leukemicpatients. All gram-positive isolates from skin infections were isolated from solid-tumorpatients. In both leukemic and solid-tumorpatients, gram-positive bacteria causing nosocomial BSI were mainly Coagulase-negative staphylococcus (CNS) and S. aureus, whereas gram-positive bacteria causing nosocomial RTI were mainly alpha-hemolytic streptococci and CNS. Gram-positive bacteria were not isolated from GI tract infections. S. aureus, CNS, and alpha-hemolytic streptococci demonstrated methicillin resistance (81.5%, 92.3%, and 90% resistance, respectively). S. aureus and CNS were susceptible to linezolid (15.4% and 0% resistance, respectively), and vancomycin (15.5% and 11% resistance, respectively). CONCLUSION: This is the first study to report the emergence of vancomycin- and linezolid-resistant S. aureus in Egypt. Newer generation quinolones (moxifloxacin and gatifloxacin) were more active than older quinolones (ciprofloxacin and ofloxacin) against S. aureus and CNS, suggesting the use of newer generation quinolones in the prophylaxis of cancerpatients.
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