M Najmuz Zafar

Muscat – A three-year study in Oman reveals there is an alarming level of antibiotic resistance in pediatric cancer patients in Oman.

Bloodstream infections (BSI) are serious and difficult oncologic complications, resulting in high morbidity and mortality. The study found that gram-negative organisms (bacteria) dominate BSIs among pediatric oncology patients in Oman, with Klebsiella (a type of gram-negative bacteria) being the most prevalent culprit, stated the study co-authored by five Omani researchers led by Abeer al Battashi, Department of Pediatric Hematology and Oncology at National Oncology Centre in The Royal Hospital.

Abeer elucidated the study found that resistance to multiple antibiotics existed in gram-negative and gram-positive bacterial groups, “which is worrisome because these antibiotics are commonly used as frontline treatment in managing febrile neutropenic cancer patients. There is a high level of resistance of gram-negative bacteria towards piperacillin-tazobactam (antibiotic)”.

The study, published in the July edition of Infection and Drug Resistance Journal, reviewed the profile and susceptibility of bacteria associated with infections in children under 13 years of age receiving chemotherapy in Oman.

Prospective cohort study of pediatric oncology patients was conducted at The Royal Hospital. A total of 74 episodes of positive bacterial blood cultures were detected in 38 oncology patients (positive blood culture rate of 51 per cent). Fifty-seven per cent were positive for gram-negative organisms with Klebsiella (21 per cent) being the most common gram-negative organism cultured, while the most common gram-positive organism was Staphylococcus (coagulase negative Staphylococcus and S Aureus) – accounting for 30 per cent of the positive cultures.

The majority of patients had gastrointestinal complaints (74 per cent), and almost half (51 per cent) had prolonged periods of neutropenia (having too few neutrophils – a type of white blood cells).

‘One third of gram-negative organisms were resistant to four or more antibiotics with a major resistance of 31 per cent to piperacillin-tazobactam. Of the gram-positive organisms, 38 per cent were resistant to at least four antibiotics and 30 per cent were pan-resistant (except for vancomycin).’

The study concluded that undertaking antibiotic stewardship rounds to provide a clear path for limiting the use of broad-spectrum antibiotics, especially in low-risk cases, and over-seeing the handling of antibiotics would be invaluable. ‘Strict infection-control and prevention practice is another cornerstone for improvement of the outcome of patients.’