Bloodstream infections in patients with malignancies: Implications for antibiotic treatment in a Ghanaian tertiary setting

Background: Bloodstream infections (BSI) remain a major cause of mortality in patients with malignancies. We present the first report on the microbiological profile of bacteraemia and fungaemia among cancer patients in Ghana. Methods: From January 2010 through December 2013, we retrospectively analyzed the spectrum of bloodstream pathogens in cancer patients from Korle-Bu Teaching Hospital, Ghana - focusing on multidrug resistant isolates (MDRs). Results: Overall BSI were confirmed in 22 % (n = 93/453) of total blood cultures. Our data highlights a co-dominance of Gram-negative (n = 49/93, 52.6 %) and Gram-positive (n = 40/93, 43.0 %) bacteria with the former less likely to infect children than adults [odds ratio (OR), 0.56; 95 % confidence interval (CI) 0.14-0.91; p value = 0.027]. Staphylococcus epidermidis was the most isolated bacteria (30.1 %; n = 28/93). About 61 % (n = 25/41) of Enterobacteriaceae isolates were resistant to cefotaxime; a majority (n = 24/25, 96 %) of which were MDRs and mostly susceptible to amikacin and levofloxacin. Four (80 %) penicillin resistant streptococci were found; 2 of which were MDRs and sensitive to erythromycin and cefuroxime. Methicillin resistant Staphylococcus aureus and vancomycin resistant enterococci were not identified. In multivariate analysis, the Enterobacteriaceae compared to other organisms were significantly associated with multidrug resistance (adjusted OR, 33.6; 95 % CI 6.41-88.73; p value 0.001). Conclusion: MDRs, especially cefotaxime resistant Enterobacteriaceae, are common among patients with cancer in our institution but vary among different patient populations. The results show that empiric antibiotic treatment for cancer patients cannot be done effectively without regard for selective antimicrobial use based on local epidemiologic data.