Antimicrobial susceptibility status of bloodstream infections in children presenting with acute lymphoblastic leukemia at Moi Teaching and Referral Hospital in Kenya

Abstract

Acute Lymphoblastic Leukaemia occurs mainly in children leading to immuno-compromised patients susceptible to bloodstream infections. Choice of antimicrobial treatment requires the epidemiological knowledge of pathogens, which constantly changes, necessitating periodic review. Knowledge of antimicrobial susceptibility profiles of pathogens would not only help in formulating an antibiotic policy, but also planning for the larger infection prevention and control measures. The aim of this study was to determine the antimicrobial profiles of bloodstream pathogens against commonly prescribed antibiotics in children presenting with ALL at the Moi Teaching and Referral Hospital. A cross-sectional study was used to investigate 80 children with ALL in MTRH with approval from MTRH Ethical Review Committee. Blood samples were collected into Bactec™ bottles for culture. Positive cultures were sub-cultured and characterized to identify the pathogens. Antimicrobial susceptibility was performed by disc diffusion method against Azithromycin, Cefuroxime, Ceftriaxone, Clindamycin, Co-trimoxazole, Cefepime, Gentamycin, Imipenem, Meropenem, Levofloxacin, Nitrofurantoin, Piperacillin/Tazobactam. The diameter of the clear zones was measured and interpreted as Susceptible, Intermediate or Resistant to a particular antimicrobial as per CLSI guidelines (CLSI, 2022). E. coli ATCC 25922 and S. aureus ATCC 1026 were used as positive controls for gram-negative and gram-positive isolates respectively. All experiments were conducted in triplicates. The analysis determined the Susceptible, Intermediate or Resistant pathogens to particular antimicrobials. A total of 24 bacteria were isolated. Coagulase negative Staphylococcus species was the most isolated at 66.67% with Acinetobacter species and Staphylococcus aureus accounting for 8.33% and 25% respectively. All isolates were 100% sensitive to Cefepime, Meropenem and Piperacillin/Tazobactam. The other antibiotics had at least one instance of intermediate sensitivity and/or antibiotic resistance recorded. The study established a statistically significant relationship between bacterial isolates associated with bloodstream infections in children presenting with acute lymphoblastic leukaemia at MTRH and their susceptibility to commonly prescribed antibiotics (p-value =0.0000; P ≤ 0.05). This study concludes that the bacterial isolates obtained from children presenting with ALL at MTRH have high sensitivity to Cefepime, Meropenem and Piperacillin/Tazobactam but minimal sensitivity to Azithromycin and Cefuroxime. Continued surveillance and periodical monitoring to determine the susceptibility profile of the most commonly isolated bloodstream pathogens in particular a population to enhance clinical approach and antibiotics treatment among children with ALL is recommended. Re-evaluation of treatment options particularly the use of Azithromycin and Cefuroxime in routine treatments should also be taken into consideration to curb antibiotic resistance.