Antimicrobial Resistance Pattern and Spectrum of Multiple-drug-resistant Enterobacteriaceae in Iranian Hospitalized Patients with Cancer

Document Type : Original Article


Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Nosocomial infections are one of the most leading causes of morbidity and mortality in patients with cancer. The emergence of multiple-drug-resistant (MDR) strains of Gram-negative bacteria causing nosocomial infection has become a serious concern in cancer patients. Therefore, the present study aimed to determine the spectrum and antibiotic resistance pattern of Gram-negative bacteria related nosocomial infections among Iranian cancer patients. Materials and Methods: This descriptive cross-sectional study was conducted during the 6 months from December 2015 to May 2016 in two tertiary care centers located in Isfahan and Arak Province. Gram-negative bacteria obtained from different clinical specimens from hospitalized patients with cancer and were identified using standard microbiological methods. Antibiotic susceptibility pattern was determined by the disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) recommendation. Results: Of totally 259 culture positive cases, Escherichia coli showed the highest isolation rate (60.6%) followed by Klebsiella pneumoniae (26.6%) and Proteus spp (11.2%). The rate of MDR isolates were 91.5% (237/259). Overall, the most frequent source of bacterial isolation was urinary tract infection (65.6%) followed by skin and soft-tissue infection (23.6%). The antibiotic susceptibility results showed meropenem (MEN) and ceftazidime as the most effective antibiotics for E. coli, K. pneumoniae, and Proteus spp. isolates. Moreover, MEN was the most effective antibiotic against MDR isolates. Conclusion: The study findings showed a significant distribution of MDR Gram-negative bacteria which may increase the burden of healthcare-associated infections in cancer patients. Although, carbapenem can be considered as effective agents toward MDR strains for empirical antibiotic therapy in our region.


Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D, et al. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.  Back to cited text no. 1
Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016;66:271-89.  Back to cited text no. 2
O'Connor A, Qasim A, O'Moráin CA. The long-term risk of continuous immunosuppression using thioguanides in inflammatory bowel disease. Ther Adv Chronic Dis 2010;1:7-16.  Back to cited text no. 3
Kamboj M, Sepkowitz KA. Nosocomial infections in patients with cancer. Lancet Oncol 2009;10:589-97.  Back to cited text no. 4
Custovic A, Smajlovic J, Hadzic S, Ahmetagic S, Tihic N, Hadzagic H, et al. Epidemiological surveillance of bacterial nosocomial infections in the surgical Intensive Care Unit. Mater Sociomed 2014;26:7-11.  Back to cited text no. 5
Cornejo-Juárez P, Vilar-Compte D, Pérez-Jiménez C, Ñamendys-Silva SA, Sandoval-Hernández S, Volkow-Fernández P, et al. The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology Intensive Care Unit. Int J Infect Dis 2015;31:31-4.  Back to cited text no. 6
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 26th Informational Supplement. Wayne, Pennsylvania: Clinical and Laboratory Standards Institute; 2016.  Back to cited text no. 7
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81.  Back to cited text no. 8
Struelens MJ. The epidemiology of antimicrobial resistance in hospital acquired infections: Problems and possible solutions. BMJ 1998;317:652-4.  Back to cited text no. 9
Abdollahi A, Hakimi F, Doomanlou M, Azadegan A. Microbial and antibiotic susceptibility profile among clinical samples of patients with acute leukemia. Int J Hematol Oncol Stem Cell Res 2016;10:61-9.  Back to cited text no. 10
Ashour HM, El-Sharif A. Species distribution and antimicrobial susceptibility of gram-negative aerobic bacteria in hospitalized cancer patients. J Transl Med 2009;7:14.  Back to cited text no. 11
Nurain AM, Bilal NE, Ibrahim ME. The frequency and antimicrobial resistance patterns of nosocomial pathogens recovered from cancer patients and hospital environments. Asian Pac J Trop Biomed 2015;5:1055-9.  Back to cited text no. 12
Nesher L, Rolston KV. The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection 2014;42:5-13.  Back to cited text no. 13
Bhat V, Gupta S, Kelkar R, Biswas S, Khattry N, Moiyadi A, et al. Bacteriological profile and antibiotic susceptibility patterns of clinical isolates in a tertiary care cancer center. Indian J Med Paediatr Oncol 2016;37:20-4.  Back to cited text no. 14
[PUBMED]  [Full text]  
Lanoix JP, Pluquet E, Lescure FX, Bentayeb H, Lecuyer E, Boutemy M, et al. Bacterial infection profiles in lung cancer patients with febrile neutropenia. BMC Infect Dis 2011;11:183.  Back to cited text no. 15
Eslami Nejad Z, Ghafouri E, Farahmandi-Nia Z, Kalantari B, Saffari F. Isolation, identification, and profile of antibiotic resistance of bacteria in patients with cancer. Iran J Med Sci 2015; 35: 109-15.  Back to cited text no. 16
Trecarichi EM, Pagano L, Candoni A, Pastore D, Cattaneo C, Fanci R, et al. Current epidemiology and antimicrobial resistance data for bacterial bloodstream infections in patients with hematologic malignancies: An Italian multicentre prospective survey. Clin Microbiol Infect 2015;21:337-43.  Back to cited text no. 17
Prabhash K, Medhekar A, Ghadyalpatil N, Noronha V, Biswas S, Kurkure P, et al. Blood stream infections in cancer patients: A single center experience of isolates and sensitivity pattern. Indian J Cancer 2010;47:184-8.  Back to cited text no. 18
[PUBMED]  [Full text]  
Moini AS, Soltani B, Taghavi Ardakani A, Moravveji A, Erami M, Haji Rezaei M, et al. Multidrug-resistant Escherichia coli and Klebsiella pneumoniae isolated from patients in Kashan, Iran. Jundishapur J Microbiol 2015;8:e27517.  Back to cited text no. 19
Dehbanipour R, Rastaghi S, Sedighi M, Maleki N, Faghri J. High prevalence of multidrug-resistance uropathogenic Escherichia coli strains, Isfahan, Iran. J Nat Sci Biol Med 2016;7:22-6.  Back to cited text no. 20
Malekzadegan Y, Hadadi M, Ebrahim-Saraie HS, Heidari H, Motamedifar M. Antimicrobial resistance pattern and frequency of multiple-drug resistant Enterobacter spp. At a tertiary care hospital in Southwest of Iran. J Krishna Inst Med Sci Univ 2017;6:33-9.  Back to cited text no. 21
Leylabadlo HE, Pourlak T, Bialvaei AZ, Aghazadeh M, Asgharzadeh M, Kafil HS, et al. Extended-spectrum beta-lactamase producing gram negative bacteria In Iran: A review. Afr J Infect Dis 2017;11:39-53.  Back to cited text no. 22
Zahedi Bialvaei A, Samadi Kafil H, Ebrahimzadeh Leylabadlo H, Asgharzadeh M, Aghazadeh M. Dissemination of carbapenemases producing gram negative bacteria in the Middle East. Iran J Microbiol 2015;7:226-46.  Back to cited text no. 23
Ashour HM, el-Sharif A. Microbial spectrum and antibiotic susceptibility profile of gram-positive aerobic bacteria isolated from cancer patients. J Clin Oncol 2007;25:5763-9.  Back to cited text no. 24