Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :1154
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
 » Next article
 » Previous article 
 » Table of Contents
  
Resource links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »  Article in PDF (615 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

 
  In this article
 »  Abstract
 »  Introduction
 »  Material and Methods
 »  Results
 »  Discussion
 »  References
 »  Article Tables

 Article Access Statistics
    Viewed6231    
    Printed296    
    Emailed4    
    PDF Downloaded779    
    Comments [Add]    
    Cited by others 31    

Recommend this journal

 


 
ORIGINAL ARTICLE
Year : 2010  |  Volume : 47  |  Issue : 2  |  Page : 184-188
 

Blood stream infections in cancer patients: A single center experience of isolates and sensitivity pattern


Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication5-May-2010

Correspondence Address:
K Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.63019

Rights and Permissions

 » Abstract 

Background : Up to 10% of patients who develop a nosocomial blood stream infection (BSI) in the hospital have an underlying malignancy. The treatment of infections in patients with malignancy often relies on the use of established guidelines along with the consideration of the local microbiology and antibiotic sensitivity patterns of possible etiologic agents. AIMS: This study attempts to identify the likely etiologic agents and the antibiotic sensitivity profile of BSIs in cancer patients. Settings and Design: This was a retrospective study. Methods and Material: The study was conducted at a tertiary care center for cancer patients, in which samples representing blood stream infections sent from the Medical Oncology services of the hospital during the year of 2007 were analysed. The microbiological profile and antibiotic sensitivity pattern of these isolates was studied. Results: There were 484 isolates that represented BSIs. The most common bacterial isolates from patients with cancer were Pseudomonas spp. (30.37%), Staphylococcus aureus (12.6%) and Acinetobacter spp. (11.57%). Meropenem was the most effective antibiotic with 71.2% sensitivity to the bacterial isolates it was tested against. Oxacillin resistance was seen in 18% of S. aureus isolates. Conclusion: Gram-negative bacteria were more common as etiologic agents of BSIs in cancer patients. The poor activity of the primary empirical agents for infections in cancer namely ceftazidime and piperacillin-tazobactam is alarming.Strict regulation of vancomycin use should be considered in areas where there is a low prevalence of methicillin-resistant S. aureus (MRSA).


Keywords: Antibiotic sensitivity, blood stream infections


How to cite this article:
Prabhash K, Medhekar A, Ghadyalpatil N, Noronha V, Biswas S, Kurkure P, Nair R, Kelkar R. Blood stream infections in cancer patients: A single center experience of isolates and sensitivity pattern. Indian J Cancer 2010;47:184-8

How to cite this URL:
Prabhash K, Medhekar A, Ghadyalpatil N, Noronha V, Biswas S, Kurkure P, Nair R, Kelkar R. Blood stream infections in cancer patients: A single center experience of isolates and sensitivity pattern. Indian J Cancer [serial online] 2010 [cited 2019 Sep 22];47:184-8. Available from: http://www.indianjcancer.com/text.asp?2010/47/2/184/63019



 » Introduction Top


Patients with cancer are predisposed to infection and often the focus of infection is not evident. Up to 10% of patients, who develop a nosocomial blood stream infection (BSI) in the hospital have an underlying malignancy. [1] Blood stream infections increase the length of hospital stay, cause significant morbidity and mortality and increase the cost of care. The crude mortality rate for BSIs in cancer patients ranges from 18 to 42%. [2],[3],[4],[5] The treatment of these infections often relies on the use of empirical therapy based on established guidelines with due consideration to the local microbiology and antibiotic sensitivity patterns. This study attempts to identify the likely etiologic agents and the antibiotic sensitivity profile of BSIs in cancer patients at a single center.


 » Material and Methods Top


This was a retrospective study conducted at a tertiary care hospital for cancer patients. We analysed all samples (from neutropenic and non-neutropenic patients) sent for bacterial culture from the Medical Oncology services of the hospital during the year of 2007. Samples that represented blood stream infections were identified. These samples included peripheral blood, blood drawn through catheters and catheter tip cultures from patients with an appropriate clinical syndrome. The bacterial isolates from these samples were identified by routine biochemical reactions. The in vitro antibiotic sensitivity pattern of these isolates was determined by the Kirby Bauer's disc diffusion method. Choice of antibiotic disks used was determined by Clinical and Laboratory Standards Institute (CLSI) guidelines. [6] Extended spectrum beta-lactamase (ESBL) production was confirmed by CLSI recommendations using cephalosporin-clavulanate combination disks. A difference of ≥5 mm between zone diameter of either of the cephalosporin disks and their respective cephalosporin-clavulanate disk was taken to be phenotypic confirmation of ESBL production. We used cefotaxime (30 μg), ceftazidime (30 μg) and ceftazidime/clavulanic acid (30 μg/10 μg) disks for ESBL determination. [6] An analysis of the microbiological spectrum and the antibiotic sensitivity pattern of the bacterial isolates were performed.

Statistical Methods

The isolates were mapped on the WHONET 5.4 software and analysed using the same program.


 » Results Top


A total of 990 isolates were cultured from all samples sent from in-patients admitted in the Medical Oncology services. Of these, a total of 516 isolates were obtained from the sample sites that represented blood stream infections. Isolates having identical antibiograms obtained from a single patient during the same hospitalization were considered once. As a result 484 isolates were analyzed. There were 154 Gram positive bacterial isolates (31.81%) and 330 Gram negative isolates (68.18%). Of these isolates, 336 were from peripheral blood (69.42%), 101 from blood drawn through a peripherally inserted central catheter (20.87%), 35 from catheter tip cultures (7.23%), 11 from blood drawn from a central catheter (2.27%) and 1 from blood drawn through a permanent catheter (0.2%).

The contribution of the most prevalent bacterial isolates is given in [Table 1]. The most common bacterial isolates were Pseudomonas spp. (30.37%), Staphylococcus aureus (12.6%), Acinetobacter spp. (11.57%) and  Escherichia More Details coli (10.95%).

Staphylococcus isolates accounted for 72.73% of all Gram positive isolates, with 61 S. aureus isolates and 51 coagulase negative Staphylococcus spp. There were 21 (13.64%) isolates belonging to Streptococcus spp. and 20 (12.99%) to Enterococcus spp.

The majority of the Gram negative bacteria were non-lactose fermenters (62.24%) with the Pseudomonas spp. and Acinetobacter spp. accounting for 147 and 56 isolates, respectively. Of the remaining Gram negative isolates, the contribution of E. coli isolates was 53 (16.06%) and that of Klebsiella pneumoniae Scientific Name Search  was 35 (10.61%).

Extended spectrum beta-lactamase production was tested in isolates from the Enterobacteriaceae group and was detected in 50 of them (15.15%). Among ESBL producers, 27 were E. coli (50.94% of E. coli isolates), 22 K. pneumoniae (62.86% of K. pneumoniae isolates) and one Enterobacter cloacae (9.09% of Enterobacter spp. isolates). Of all ESBL producers, 43 isolates were isolated from peripheral blood culture (86%) and 7 from blood drawn through a peripherally inserted central catheter (14%).

The antibiotic sensitivity pattern of the most prevalent Gram negative bacteria is given in [Table 2].

There was a high degree of resistance to the cephalosporins with only 27.1% of the Gram negative isolates being sensitive to the third generation cephalosporins, namely ceftriaxone and cefotaxime. The overall activity of the anti-pseudomonal cephalosporin, ceftazidime (CAZ), was better at 43.6%. However, this was due to its expectedly better anti-pseudomonal activity (52.4%). The susceptibility of E. coli and K. pneumoniae isolates of the third generation cephalosporins ranged between 18.9 to 22.6 and 25.7 to 28.6% v/s, respectively.

The beta-lactam/beta-lactamase inhibitor combinations fared better in the overall activity against Gram negative bacteria [48.8% susceptibility for piperacillin-tazobactam (TZP) and 58.5% for cefoperazone-sulbactam (CFS)]. The sensitivity of Pseudomonas spp. to the combination antibiotics was comparable to that of ceftazidime (55.2% v/s 52.4%), however the activity of the beta-lactam/beta-lactamase inhibitors against E. coli isolates was much better (75.5% for CFS; 49.1% for TZP; 22.6% for CAZ). However, poor efficacy of beta-lactam combinations against the Acinetobacter spp. was found (32.1% for TZP and 48.2% for CFS).

Meropenem was the most effective antibiotic and was active against 71.7% of the Gram negative bacterial isolates. There was no resistance documented against Klebsiella pneumoniae but resistance among E. coli was emerging (8.5%). It was the most active antimicrobial agent against Pseudomonas spp. (66.2%), however activity against Acinetobacter spp. was poor (38.9%).

The aminoglycosides and quinolones showed variable activity. The overall activity against all Gram negative bacterial isolates tested was poor (32% susceptibility for ciprofloxacin and 40.4% for amikacin). There was a high degree of resistance among the Pseudomonas spp. for both antibiotics (74.5% resistance against ciprofloxacin and 75.9% for amikacin). The poor activity of ciprofloxacin against E. coli (20% susceptible) was disconcerting.

The antibiotic sensitivity patterns for the Gram positive organisms revealed that linezolid was the most active agent. All the bacterial isolates tested were sensitive to linezolid and no resistance was documented. The activity of ciprofloxacin and erythromycin against the various Gram positive bacterial isolates was variable but in general suboptimal. Percentage of antibiotic resistance for Gram positive organisms is given in [Table 3].

Oxacillin resistance was observed in 18% of S. aureus isolates and 33.4% of coagulase negative Staphylococcus isolates. All these isolates were sensitive to vancomycin and teicoplanin. Clindamycin resistance was low among Staphylococcus isolates and was documented among 6.6% of S. aureus and 5.9% of coagulase negative Staphylococcus isolates.

Vancomycin resistant enterococci accounted for 50% of the Enterococcus spp. isolates. Teicoplanin resistance was evident in 15% of the Enterococcus isolates and an additional 35% Enterococcus isolates showed intermediate sensitivity.


 » Discussion Top


Blood stream infections are a cause of significant morbidity and mortality in cancer patients. The incidence of BSIs among neutropenic patients is 11-38%. [7],[8],[9] The causative organisms of BSIs have changed over time. In the 1960s to the 70s, Gram negative bacteria were more predominant causative agents but over the last few decades there has been a shift toward predominance by Gram positive bacteria. [1] There have been reports suggesting 70-81% of the bacteria isolated from BSIs are Gram positive. [10],[11]

Our study however revealed that Gram negative bacteria were predominant. This has been an observation among similar studies done in patients in the developing countries. [12],[13],[14],[15],[16] The reasons for this could be the relatively lower use of indwelling catheters and other portal devices as well as low utilization of prophylactic antibiotic regimens in neutropenic patients. [17] Our institute does not use empirical antibiotics for prevention of bacterial infections among cancer patients, and the use of long duration indwelling catheters is generally restricted to patients with acute myeloid leukemia for the duration of high dose cytarabine therapy.

The high occurrence of non-lactose fermenters especially Pseudomonas spp. and Acinetobacter spp. was of concern. Both of these bacteria are associated with a high degree of resistance to antibiotics. Blood stream infections with P. aeruginosa have been associated with increased mortality in some studies. [18],[19] Acinetobacter spp. have emerged as prominent multidrug-resistant bacteria in several intensive care units all over the world, and their occurrence in the setting of malignancy could be disastrous. There have been no studies, to our best knowledge, that have had such a high burden of BSIs due to non-lactose fermenters. It is probable that low utilization of home-based chemotherapy meant longer and more frequent hospitalization at our institute, and concomitant greater risk of acquisition of these hospital-based bacterial infections.

The occurrence of methicillin-resistant S. aureus (MRSA) was low (18%) in our study; also there were fewer oxacillin-resistant (33.4%) coagulase negative Staphylococcus (CoNS) isolates. This is rather different from prevalence rates in most other studies. [12],[13],[14],[15],[16],[20] This suggests that the utilization of empirical vancomycin at our institute must be thoroughly scrutinized. The indiscriminate use of vancomycin has promoted resistance and this is evident by the high occurrence of vancomycin-resistant Enterococcus isolates (50% of all Enterococcus isolates in the study). Strict regulation of the use of vancomycin should therefore be considered in areas where there is a low prevalence of MRSA.

The poor activity of the primary empirical agents for infections in cancer namely ceftazidime and piperacillin-tazobactam (43.6 and 48.4% susceptibility, respectively) is alarming. The high resistance to amikacin (59.1%) further compounds the problem. The only available alternative antimicrobial agents are carbapenems. But even here resistance has been documented high (28.8%). The poor activity of meropenem against Pseudomonas spp. and Acinetobacter spp. is especially distressing. This is a grim situation and there is an urgent need for the development of newer agents for the treatment of Gram negative infections. While polymyxin, chloramphenicol and cotrimoxazole are being revisited as possible choices for the treatment, there remains a growing requirement for novel agents. [21] Doripenem, tigecycline and ceftobiprole are now available but with the degree of resistance we have encountered in this study, it is a matter of time before these antibiotics are exhausted. Sound hospital infection control practices, decreased reliance on hospital-based care and restricted antibiotic use would go a long way in improving an all too familiar dismal situation in developing countries.

 
 » References Top

1.Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB. Current Trends in the Epidemiology of Nosocomial Bloodstream Infections in Patients with Hematological Malignancies and Solid Neoplasms in Hospitals in the United States. Clin Infect Dis 2003;36:1103-10.  Back to cited text no. 1      
2.Collin BA, Leather HL, Wingard JR, Ramphal R. Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis 2001;33:947-53.   Back to cited text no. 2      
3.Krupova I, Kaiserova E, Foltinova A, Kovacicova G, Kiskova M, Krchnakova A, et al. Bacteremia and fungemia in pediatric versus adult cancer patients after chemotherapy: Comparison of etiology, risk factors and outcome. J Chemother 1998;10:236-42.   Back to cited text no. 3      
4.Krcmιry V Jr, Spanik S, Krupova I, Trupl J, Kunova A, Smid M, et al. Bacteremia due to multiresistant gram-negative bacilli in neutropenic cancer patients: A case controlled study. J Chemother 1998;10:320-5.   Back to cited text no. 4      
5.Ehni WF, Reller LB, Ellison RT 3 rd . Bacteremia in granulocytopenic patients in a tertiary-care general hospital. Rev Infect Dis 1991;13:613-9.   Back to cited text no. 5      
6.Clinical and Laboratory Standards Institute; 2008 Performance standards for antimicrobial susceptibility testing; Eighteenth informational supplement. M100-S18. CLSI, Wayne, PA.  Back to cited text no. 6      
7.Madani TA. Clinical infections and bloodstream isolates associated with fever in patients undergoing chemotherapy for acute myeloid leukemia. Infection 2000;28:367-73.   Back to cited text no. 7      
8.Gaytαn-Martνnez J, Mateos-Garcνa E, Sαnchez-Cortιs E, Gonzαlez-Llaven J, Casanova-Cardiel LJ, Fuentes-Allen JL. Microbiological findings in febrile neutropenia. Arch Med Res 2000;31:388-92.   Back to cited text no. 8      
9.Serody JS. Fever in immunocompromised patients. N Engl J Med 2000;342:217-8.  Back to cited text no. 9      
10.Rubio M, Palau L, Vivas JR, del Potro E, Diaz-Mediavilla J, Alvarez A, et al. Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies. Infect Control Hosp Epidemiol 1994;15:101-4.   Back to cited text no. 10      
11.Gonzαlez-Barca E, Fernαndez-Sevilla A, Carratalα J, Graρena A, Gudiol F. Prospective study of 288 episodes of bacteremia in neutropenic cancer patients in a single institution. Eur J Clin Microbiol Infect Dis 1996;15:291-6.  Back to cited text no. 11      
12.Figuera Esparza M, Carballo M, Silva M, Figueredo A, Avilαn J. Microbiological isolates in patients with febrile neutropenia and hematological neoplasias [Article in Spanish]. Rev Esp Quimioter 2006;19:247-51.  Back to cited text no. 12      
13.Butt T, Afzal RK, Ahmad RN, Salman M, Mahmood A, Anwar M. Bloodstream infections in febrile neutropenic patients: Bacterial spectrum and antimicrobial susceptibility pattern. J Ayub Med Coll Abbottabad 2004;16:18-22.  Back to cited text no. 13      
14.Chen CY, Tang JL, Hsueh PR, Yao M, Huang SY, Chen YC, et al. Trends and antimicrobial resistance of pathogens causing bloodstream infections among febrile neutropenic adults with hematological malignancy. J Formos Med Assoc 2004;103:526-32.  Back to cited text no. 14      
15.Velasco E, Byington R, Martins CS, Schirmer M, Dias LC, Gonηalves VM. Bloodstream infection surveillance in a cancer centre: A prospective look at clinical microbiology aspects. Clin Microbiol Infect 2004;10:542-9.  Back to cited text no. 15      
16.Paul M, Gafter-Gvili A, Leibovici L, Bishara J, Levy I, Yaniv I, et al. The epidemiology of bacteremia with febrile neutropenia: Experience from a single center, 1988-2004. Isr Med Assoc J 2007;9:424-9.  Back to cited text no. 16      
17.Feld R. Bloodstream infections in cancer patients with febrile neutropenia. Int J Antimicrob Agents 2008;32:S30-3.  Back to cited text no. 17      
18.Cherif H, Kronvall G, Bjφrkholm M, Kalin M. Bacteraemia in hospitalised patients with malignant blood disorders: A retrospective study of causative agents and their resistance profiles during a 14-year period without antibacterial prophylaxis. Hematol J 2003;4:420-6.  Back to cited text no. 18      
19.Spanik S, Kukuckova E, Pichna P, Grausova S, Krupova I, Rusnakova V, et al. Analysis of 553 episodes of monomicrobial bacteraemia in cancer patients: Any association between risk factors and outcome to particular pathogen? Support Care Cancer 1997;5:330-3.  Back to cited text no. 19      
20.Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997-2002). Diagn Microbiol Infect Dis 2004;50:59-69.  Back to cited text no. 20      
21.Vergidis PI, Falagas ME. New antibiotic agents for bloodstream infections. Int J Antimicrob Agents 2008;32:S60-5.  Back to cited text no. 21      



 
 
    Tables

  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea
Sung-Yeon Cho,Hyeon-Jeong Lee,Dong-Gun Lee
The Korean Journal of Internal Medicine. 2018; 33(2): 256
[Pubmed] | [DOI]
2 Cefepime vs. cefoperazone/sulbactam in combination with amikacin as empirical antibiotic therapy in febrile neutropenia
M. Ponraj,Biswajit Dubashi,B. H. Harish,S. Kayal,S. L. Cyriac,Jogamaya Pattnaik,K. Ranjith,Unni S. Pillai,Naresh Jadhav,Kiran K. Matta,Jagdeep Singh,Esha Jaffa,Bhanu Prakash
Supportive Care in Cancer. 2018; 26(11): 3899
[Pubmed] | [DOI]
3 The challenge of antibiotic resistance in haematology patients
Ola Blennow,Per Ljungman
British Journal of Haematology. 2016; 172(4): 497
[Pubmed] | [DOI]
4 Bloodstream infections in neutropenic cancer patients: A practical update
Giulia Gustinetti,Malgorzata Mikulska
Virulence. 2016; 7(3): 280
[Pubmed] | [DOI]
5 Pneumococcal Bacteremia in Patients With Cancer
Abraham Tareq Yacoub,Raphael Monta,Sharoon Quaiser,Ileana Acevedo,John Greene
Infectious Diseases in Clinical Practice. 2015; 23(5): 263
[Pubmed] | [DOI]
6 Bacteremia in Cancer Patients: A Two Center Experience of Isolates and Spectrum of Antibiotic Resistance Pattern
Mohammad Hadi Naseh,Seyed Mahmoud Amin Marashi,Esfandiar Asgari,Maryam Aghabarari,Ellaheh Mahmudi,Mozhan Asadi,Shiva Hatami,Enayatollah Kalantar
Jundishapur Journal of Natural Pharmaceutical Products. 2015; 10(3)
[Pubmed] | [DOI]
7 Antibiotic resistance profile of non-fermenting Gram-negative bacilli isolated from the blood cultures of cancer patients
AhmedNishat Hussain,AhmedNishat Kausalya,RajeshK Grover,FrincyK Baruah
Journal of Global Infectious Diseases. 2015; 7(1): 46
[Pubmed] | [DOI]
8 Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer
Enrico M. Trecarichi,Mario Tumbarello
Current Opinion in Infectious Diseases. 2014; 27(2): 200
[Pubmed] | [DOI]
9 Cancer and the microbiome: potential applications as new tumor biomarker
Khan Shahanavaj,Ignacio Gil-Bazo,Marta Castiglia,Giuseppe Bronte,Francesco Passiglia,Anna P Carreca,José Luis del Pozo,Antonio Russo,Marc Peeters,Christian Rolfo
Expert Review of Anticancer Therapy. 2014; : 1
[Pubmed] | [DOI]
10 result 1 Document Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer: Current epidemiology and clinical impact
Trecarichi, E.M., Tumbarello, M.
Current Opinion in Infectious Diseases. 2014;
[Pubmed]
11 Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance
E. Montassier,E. Batard,T. Gastinne,G. Potel,M. F. Cochetičre
European Journal of Clinical Microbiology & Infectious Diseases. 2013; 32(7): 841
[Pubmed] | [DOI]
12 Signaling pathways bridging microbial-triggered inflammation and cancer
Maulilio John Kipanyula,Paul Faustin Seke Etet,Lorella Vecchio,Mohammed Farahna,Elias Nchiwan Nukenine,Armel Hervé Nwabo Kamdje
Cellular Signalling. 2013; 25(2): 403
[Pubmed] | [DOI]
13 Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients
Malgorzata Mikulska,Claudio Viscoli,Christina Orasch,David M. Livermore,Diana Averbuch,Catherine Cordonnier,Murat Akova
Journal of Infection. 2013;
[Pubmed] | [DOI]
14 result 3 Document Prospective study estimating healthcare associated infections in a paediatric hemato-oncology unit of a tertiary care hospital in north India
Gupta, A., Kapil, A., Kabra, S.K., (...), Das, B.K., Sreenivas, V.
Source of the Document Indian Journal of Medical Research. 2013;
[Pubmed]
15 Aspiration in Head and Neck Cancer Patients: A Single Centre Experience of Clinical Profile, Bacterial Isolates and Antibiotic Sensitivity Pattern
K. C. Lakshmaiah,Nagesh T. Sirsath,Jayshree R. Subramanyam,Babu K. Govind,D. Lokanatha,Ashok M. Shenoy
Indian Journal of Otolaryngology and Head & Neck Surgery. 2013; 65(S1): 144
[Pubmed] | [DOI]
16 result 2 Document Pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients
Fayyaz, M., Mirza, I.A., Ikram, A., (...), Ghafoor, T., Shujat, U.
Source of the Document Journal of the College of Physicians and Surgeons Pakistan. 2013;
[Pubmed]
17 Recent changes in bacteremia in patients with cancer: A systematic review of epidemiology and antibiotic resistance
Montassier, E. and Batard, E. and Gastinne, T. and Potel, G. and De La Cochetière, M.F.
European Journal of Clinical Microbiology and Infectious Diseases. 2013; 32(7): 841-850
[Pubmed]
18 Signaling pathways bridging microbial-triggered inflammation and cancer
Kipanyula, M.J. and Seke Etet, P.F. and Vecchio, L. and Farahna, M. and Nukenine, E.N. and Nwabo Kamdje, A.H.
Cellular Signalling. 2013; 25(2): 403-416
[Pubmed]
19 Antimicrobial susceptibility profiles of Gram-negative bacilli and Gram-positive cocci isolated from cancer patients in Libya
Zorgani, A.A. and Belgasim, Z. and Ziglam, H. and Ghenghesh, K.S.
Archives of Clinical Microbiology. 2012; 3(3)
[Pubmed]
20 Utility of peripheral blood cultures in patients with cancer and suspected blood stream infections: A systematic review
RodrĂ­guez, L. and Ethier, M.-C. and Phillips, B. and Lehrnbecher, T. and Doyle, J. and Sung, L.
Supportive Care in Cancer. 2012; 20(12): 3261-3267
[Pubmed]
21 Emergence of multidrug resistant acinetobacter blood stream infections in febrile neutropenia patients with haematological cancers and bone marrow failure syndromes
Sood, P. and Seth, T. and Kapil, A. and Sharma, V. and Dayama, A. and Sharma, S. and Kumar, S. and Singh, A.K. and Mishra, P. and Mahapatra, M.
Journal of the Indian Medical Association. 2012; 110(7): 439-444
[Pubmed]
22 Profile of infections and outcome in high-risk febrile neutropenia: Experience from a tertiary care cancer center in India
Ghosh, I. and Raina, V. and Kumar, L. and Sharma, A. and Bakhshi, S. and Thulkar, S. and Kapil, A.
Medical Oncology. 2012; 29(2): 1354-1360
[Pubmed]
23 Bacterial lung sepsis in patients with febrile neutropenia
Lanoix, J.-P., Schmit, J.-L., Douadi, Y.
Current Opinion in Pulmonary Medicine. 2012; 18(3): 175-180
[Pubmed]
24 Utility of peripheral blood cultures in patients with cancer and suspected blood stream infections: a systematic review
Laura Rodríguez,Marie-Chantal Ethier,Bob Phillips,Thomas Lehrnbecher,John Doyle,Lillian Sung
Supportive Care in Cancer. 2012; 20(12): 3261
[Pubmed] | [DOI]
25 Profile of infections and outcome in high-risk febrile neutropenia: experience from a tertiary care cancer center in India
Indranil Ghosh,Vinod Raina,Lalit Kumar,Atul Sharma,Sameer Bakhshi,Sanjay Thulkar,Arti Kapil
Medical Oncology. 2012; 29(2): 1354
[Pubmed] | [DOI]
26 Bacterial lung sepsis in patients with febrile neutropenia
Jean-Philippe Lanoix,Jean-Luc Schmit,Youcef Douadi
Current Opinion in Pulmonary Medicine. 2012; 18(3): 175
[Pubmed] | [DOI]
27 Emergence of tigecycline & colistin resistant Acinetobacter baumanii in patients with complicated urinary tract infections in north India
Taneja, N., Singh, G., Singh, M., Sharma, M.
Indian Journal of Medical Research, Supplement. 2011; 133(6): 681-684
[Pubmed]
28 The antibiotic resistance patterns of Pseudomonas aeruginosa strains isolated from blood cultures specimens in the medical microbiology laboratory of gulhane military medical academy | [GATA Tibbi Mikrobiyoloji Laboratuvarinda hemokültür örneklerinden izole edilen Pseudomonas aeruginosa suşlarinin antibiyotik direnç durumlari]
Güney, M., Bedir, O., Kiliç, A., Basuştaoǧlu, A.C.
Gulhane Medical Journal. 2011; 53(2): 119-122
[Pubmed]
29 Is screening patients for antibiotic-resistant bacteria justified in the Indian context
Bhattacharya, S.
Indian Journal of Medical Microbiology. 2011; 29(3): 213-217
[Pubmed]
30 Trends in nosocomial bloodstream infections in a burn intensive care unit: An eight-year survey
Zorgani, A., Franka, R.A., Zaidi, M.M., Alshweref, U.M., Elgmati, M.
Annals of Burns and Fire Disasters. 2010; 23(2): 88-94
[Pubmed]
31 Changing trends of in vitro antimicrobial resistance patterns in blood isolates in a tertiary care hospital over a period of 4 years
Gupta, A. and Sharma, S. and Arora, A. and Gupta, A.
Indian Journal of Medical Sciences. 2010; 64(11): 485-492
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow