RS sample: Can be guide for empirical treatment of haematological malignancy patients?

Neutropenia due to intensive chemotherapy in haematological malignancy patients leaves the host vulnerable and makes them susceptible to infections. Infections are the most important cause of morbidity and mortality especially in haematological malignancy and chemotherapy patients. In addition, the use of multiple or inappropriate antibiotics leads to the development of resistant microorganisms. Therefore, the choice of empirical treatment is of vital important in these patient groups. Escherichia coli, Acinetobacter baumannii and Klebsiella pneumoniae are among the most frequently isolated Gram negative bacteria in neutropenic patients. Rectal swab (RS) samples were obtained from haematological malignancy patients not yet on chemotherapy or have no infection on chemotherapy period, E. coli was isolated from these samples, and A. baumannii and K. pneumoniae colonization were investigated. Susceptibilities of bacteria against antibiotics used in empirical treatment and prophylaxis were determined by using Gradient test strips according to the EUCAST recommendation. All isolates were sensitive against colistin. The resistant rates of antibiotics were detected as 39.1%, 9.4%, 6.8%, 35.1%, 31%, 39.1% for ciprofloxacin, meropenem, imipenem, piperacillin-tazobactam, cefepime, ceftazidime respectively The clonal relationship between Gram negative bacteria of intestinal flora and infection agents of same patient was investigated by Pulsed-Field gel electrophoresis. Twenty-three of the 30 patients (76.6%) were found to have a clonal relationship between the bacterial isolates before and after infection. It was determined that it can be able to predict with RS samples about possible agents of infection and their antibiotic susceptibility patterns.