RECURRENT URINARY TRACT INFECTIONS IN IRAQI LEUKEMIC PATIENTS. -

Background:- Despite significant advances in supportive care, infectious complications continue to be a significant cause of morbidity and mortality in leukemia patients. The development of effective chemotherapy regimens, incorporation of monoclonal antibodies, use of consolidation and maintenance strategies, and increased use of indwelling urinary catheters have increased susceptibility to urinary tract infections (UTIs) in patients with leukemia. Multidrug resistant organisms have emerged; even under the optimal circumstances as on time diagnosis and application of proper therapy, infections in leukemia remain a therapeutic challenge. On the other spectrum any delayed recognition or poor application of proper therapy will lead to significant morbidity and mortality while potentially increasing the economic burden associated with the infections seen in this immunocompromised population. Patients and Methods:- The present study was carried out in the teaching laboratories / medical city/ Baghdad through a period from beginning of May 2015 till the end of September 2015 applied upon 100 leukemic patients seeking the teaching hospital and complaining from recurrent urinary tract infections (UTIs) signs and symptoms during their chemotherapy taking courses. 74 specimens given a positive culture results from the total 100; while 26 specimens given no significant cultivation results. In addition at the same time took another 50 patients whom complaining also from urinary tract infections signs and symptoms as a control group, 23 given a positive culture results and the rest of 50 chosen attempted patients given a negative cultivation results. Clean cached mid stream urine samples were taken in sterile sample containers from both groups and general urine examination were carried out upon them plus the biochemical assays through urinary dipsticks, then cultivate our specimens, incubate in ambient incubator at 35 ?C-37 ?C for 18-24 hours. The agents used in the present study were (Amikacin, Augmentin, Cefotaxime, Ceftriaxone, Cefoxitin, Cefepime, Ceftazidime, Ciprofloxacin, Levofloxacin, Gentamicin, Imipenem, Nitrofurantoin, Rifampicin, and Sulphamethoxazole-Trimethoprime). Results:-The most distributable microbes among leukemia patients were gram-negative bacteria; Escherichia coli 21 isolates, Klebsiella pneumoniae 18 isolates, Enterobacter cloacae 8 isolates, Enterobacter aerogenes 7 isolates, Pseudomonas aeruginosa 6 isolates, Serratia marcescens 3 isolates, Proteus mirabilis 3 isolates. The gram-positive bacteria causative etiologies were; Enterococcus faecalis 6 isolates, Enterococcus faecium 2 isolates; beside Candida albicans were so isolated from 14 cases from the chosen leukemic patients. Regarding the included control group the predominant pathogenic microorganisms were Escherichia coli 9 isolates, Klebsiella pneumoniae 4 isolates , Enterobacter cloacae 3 isolates, Proteus mirabilis 2 isolates, and Pseudomonas aeruginosa one isolate; and the gram-positive bacteria causative etiologies were; Enterococcus faecalis 3 isolates, Staphylococcus saprophyticus one isolate. The majority of the 66 gram-negative isolates were susceptible equally to Amikacin and Nitrofurantoin (43 isolates), Imipenem (41 isolates), (Gentamicin (38 isolates), Levofloxacin (29 isolates), Cefoxitin (16 isolates), Ceftriaxone (13 isolates), Sulphamethoxazole-Trimethoprime (10 isolates), Rifampicin (7 isolates). Lastly (3 isolates) were susceptible to the rest already used antimicrobial agents. According to the isolated 8 gram-positive microbes; mostly was susceptible to Levofloxacin (6 isolates), then came Sulphamethoxazole-Trimethoprime (5 isolates), then Imipenem (4 isolates), Cefoxitin (3 isolates), and at last (one isolate) was susceptible to the rest already used antimicrobial agents. The action of the antimicrobial agents regarding the microbial pathogens whom isolated from the control group was the same as occurred in the leukemia group. Conclusions:- gram-negative bacteria Escherichia coli were the most common organisms isolated from leukemia patients gained recurrent UTIs, followed by Klebsiella pneumoniae. The antimicrobial susceptibility testing results that most of the isolated microorganisms were equally susceptible to Amikacin and Nitrofurantoin, then came Imipenem, Gentamicin, Levofloxacin, Cefoxitin, Ceftriaxone, Sulphamethoxazole-Trimethoprime, and Rifampicin - See more at: