Bacteriological profile and antibiogram of cancer patients admitted in intensive care unit of a tertiary care cancer hospital in central Kerala

Sanjana Ramakrishnan, Sourabh Radhakrishnan, Sonu Lazar Cyriac


Background: Opportunistic bacterial infections remain a serious morbidity among cancer patients. This study was aimed to determine the bacteriological and antibiotic profile of cancer patients admitted to the ICU of a tertiary care centre.

Methods: Cross sectional study was done among cancer patients admitted in the Oncology neutropenic ICU during the period from August 2017 to July 2019. All patients admitted with a proven diagnosis of cancer for whom at least one bacterial culture was sent from any site were included in the study. Laboratory on culture reports were obtained from patient files and analysed.

Results: A total of 278 samples from 256 patients (60±11.6 years) were analysed. Among the 111/278 positive cultures, 29 were blood samples and 1 was a pleural fluid sample. Gram negative organisms were 62.1% with Escherichia coli (25, 36.2%) as prevalent. Among the 37.8% gram positives, Staphylococcus aureus (18. 42.8%) was prevalent. Most of the E. coli strains showed highest resistance to ceftazidime (96%) and highest sensitivity to amikacin. The commonest gram-positive organism, Staphylococcus species were 100 % sensitive to vancomycin and linezolid and 100 % resistance to penicillin.  

Conclusions: E. coli (gram negative) showed highest resistance to ceftazidime and sensitivity to amikacin. S. aureus (gram positive) was sensitive to vancomycin and linezolid and resistance to penicillin. An antibiogram for cancer patients helps the clinician to initiate an appropriate empirical antibiotic therapy to reduce mortality and morbidity.


Antibiogram, Bacterial infections, Gram positives, Gram negative, Myelo-suppression, Neutropenia

Full Text:



Whimbey E, Goodrich J, Bodey GP. Pneumonia in cancer patients. Cancer Treat Res. 1995;79:185-210.

Evans SE, Ost DE. Pneumonia in the neutropenic cancer patient. Curr Opin Pulm Med. 2015;21(3):260-71.

Safdar A, Armstrong D. Infectious morbidity in critically ill patients with cancer. Crit Care Clin. 2001;17(3):531-70

Yoo SS, Cha SI, Shin KM, Lee SY, Kim CH, Park JY, Jung TH. Bacterial pneumonia following cytotoxic chemotherapy for lung cancer: clinical features, treatment outcome and prognostic factors. Scand J Infect Dis. 2010;42(10):734-40.

Frost I, Van Boeckel TP, Pires J, Craig J, Laxminarayan R. Global geographic trends in antimicrobial resistance: the role of international travel. J Travel Med. 2019;26(8):36.

Garg VK, Mishra S, Gupta N, Garg R, Sachidanand B, Vinod K, et al. Microbial and Antibiotic Susceptibility Profile among Isolates of Clinical Samples of Cancer Patients Admitted in the Intensive Care Unit at Regional Tertiary Care Cancer Center: A Retrospective Observational Study. Indian J Critical Care Med. 2019;23(2):67-72.

Dixit A, Kumar N, Kumar S, Trigun V. Antimicrobial Resistance: Progress in the Decade since Emergence of New Delhi Metallo-β-Lactamase in India. Indian J Community Med. 2019;44(1):4-8

Kumar SG, Adithan C, Harish BN, Sujatha S, Roy G, Malini A. Antimicrobial resistance in India: A review. J Nat Sci Biol Med. 2013;4(2):286-91.

Agrawal V, Shrivastava TP, Adusumilli PK, Vivekanandan K, Thota P, Bhushan S. Pivotal role of Pharmacovigilance Programme of India in containment of antimicrobial. resistance in India. Perspect Clin Res. 2019;10(3):140-4.

Al-Otaibi FE, Bukhari EE, Badr M, Alrabiaa AA. Prevalence and risk factors of Gram-negative bacilli causing blood stream infection in patients with malignancy. Saudi Med J. 2016;37(9):979-84.

Viscoli C, Varnier O, Machetti M. Infections in Patients with Febrile Neutropenia: Epidemiology, Microbiology, and Risk Stratification. Clinic Infect Disea. 2005;40:S240-5.

Nazneen S, Mukta K, Santosh C, Borde A. Bacteriological trends and antibiotic susceptibility patterns of clinical isolates at Government Cancer Hospital, Marathwada. Ind J Canc. 2016;53(4), 583.

Rudresh SM, Nagarathnamma T Extended spectrum β-lactamase producing Enterobacteriaceae & antibiotic co-resistance. Indian J Med Res. 2011;133:116-8.

Heather L. Preventing infection in immunocompromised cancer patients: latest recommendations. Oncol Tim. 2008;30(18):25-8.

Kalathil SG, Thanavala Y. High immunosuppressive burden in cancer patients: a major hurdle for cancer immunotherapy. Canc Immunol Immunother. 2016;65(7):813-9.