Prevalence and aetiology of Bactereamia among children with Lymphomas on Cancer Chemotherapy at the Uganda Cancer Institute

Abstract

Introduction: The prevalence of cancers has been noted to be on the increase worldwide. In Africa this increase has mainly been attributed to viral infections especially mv. Lymphomas are currently the commonest childhood cancers seen in Uganda. Although chemotherapy remains the most widely used treatment modality for most childhood cancers, it is associated with bone marrow suppression, and this predisposes these children to severe bacterial infections that are fatal if not treated with appropriate antibiotics. This study was therefore set to determine the common bacterial organisms and their sensitivity patterns in children on cancer chemotherapy at the institute. Objective: To determine the prevalence and aetiology of bacteraemia among children with lymphomas initiated on cancer chemotherapy at the UCI. Methods: This was a cross sectional descriptive study, carried out at the UCI, Mulago hospital between November 2008 and March 2009 among children with lymphomas on cancer chemotherapy. A total of 140 study participants were consecutively enrolled. Information was entered in a data collection tool. A Blood sample was drawn for malaria parasites smear, full blood count, culture and sensitivity. HIV and CD4 cell results were accessed through the hospital records where applicable. Data was entered into Epi data version 3.1 and analyzed using SPSS version 11. Results: Eight (5.7%) of 140 study participants enrolled had bacteraemia .The aetiology of bacteraemia was mainly gram negative organisms 5/8 (62.5%). Staphylococcus aureus was the only gram positive organism identified and it accounted for 37.5 % (3/8) of the positive blood cultures. All the gram negative organisms were sensitive to gentamicin, ceftriaxone and ciprofloxacin except for 1 multidlUg resistant (MDR) E.coli. Resistance to penicillins and cotrimoxazole by positive organisms was high. Dehydration, presence of fever and low platelet counts were found to be associated with bacteraemia at bivariet analysis. Conclusions: The prevalence of bacteraemia among children with lymhomas at the Uganda Cancer Institute was low at 5.7%. The gram negative organisms were the commonest cause of bacteraemia accounting for 62.5 % and all the gram negative organisms were sensitive to gentamicin, ceftriaxone, ciprofloxacin except for 1 MDR E.coli. Resistance to penicillins and cotrimoxazole by positive organisms was high. Recommendations: Children with lymphomas on chemotherapy with suspected bacteraemia should be started on treatment which covers mainly gram negative organisms or both as they wait for blood culture results. A larger study should be conducted on children with cancer on chemotherapy to study the factors associated with bacteraemia among patients with cancers.