Microbial spectrum and susceptibility profile of opportunistic pathogens isolated from cancer patients attending a tertiary healthcare centre in Akure, Nigeria

Authors

  • Olumide Oluyele Federal University of Technology Akure, Nigeria https://orcid.org/0000-0003-1810-4986
  • Muftau Kolawole Oladunmoye Federal University of Technology Akure, Nigeria
  • Ayodele Oluwayemisi Ogundare Federal University of Technology Akure, Nigeria
  • Anthony Kayode Onifade Federal University of Technology Akure, Nigeria
  • Ndidi Aishat Okunnuga University of Medical Sciences Teaching Hospital, Akure, Nigeria

DOI:

https://doi.org/10.54034/mic.e1961

Keywords:

cancer, infection, antimicrobial-agents, antimicrobial-resistance

Abstract

Introduction. Cancer constitutes a formidable global public health challenge, infection complicates effective treatment regimen and detrimentally impacts survival in cancer-patients. This predicament is exacerbated by the rising specter of antimicrobial resistance. Methods. The study was conducted amongst clinically diagnosed cancer patients attending University of Medical Sciences Teaching Hospital, Akure. Characterization of bacterial and fungal isolates from blood samples of the patients was performed using standard microbiological procedures. Antimicrobial susceptibility assessment was performed using disk diffusion and microdilution methods. Results. Overall, 40.3% of cancer cases manifested in individuals aged above 60 years, with breast cancer emerging as the predominant malignancy, accounting for 68.1% of cases. Moreover, retirees constituted the demographic with the highest representation among the cancer patients, encompassing 36.8% of the study population. The prevailing bacterial isolates comprised Klebsiella pneumoniae (25%) and Klebsiella aerogenes (18.75%), while Aspergillus fumigatus (30.12%) and Candida albicans (24.09%) constituted the predominant fungal isolates. Remarkably, the antimicrobial agents Cefuroxime, Cotrimoxazole, and Amphotericin-B exhibited suboptimal efficacy against these isolates. Conclusion. This study shows the increased vulnerability of cancer patients to opportunistic bacterial and fungal pathogens, many of which show resistance to conventional antimicrobial agents. Strict infection prevention and antimicrobial stewardship measures are advocated to reduce infections in this susceptible population.

References

Klaunig JE. Carcinogenesis. An Introduction to Interdisciplinary Toxicology. 6th Edition, United States. Elsevier Inc, 2020, Chapter 8, pp 97-109.

WHO (World Health Organization). Cancer Fact Sheet, Retrieved from: WHO https://www.who.int/news-room/fact-sheets/ detail/cancer. Accessed March 3, 2022.

Hanahan D. and Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011; 144: 652–674.

Siegel RL, Miller KD, Fuchs HE and Jemal A. Cancer statistics, 2022. CA: Cancer Journal for Clinicians 2022; 72 (1): 7-33.

ACS (American Cancer Society). Global Cancer Facts and Figures 2018; GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer Journal for Clinicians. 4th, Edition. Accessed 31, May, 2022.

Soerjomataram I. and Bray F. Planning for tomorrow: global cancer incidence and the role of prevention 2020–2070. Nature Reviews Clinical Oncology 2021; 18 (10): 663-672.

Chinowaita F, Chaka W, Nyazika TK, Maboreke TC, Tizauone E, Mapondera P, Chitsike I, Cakana AZ and Mavenyengwa RT. Sepsis in cancer patients residing in Zimbabwe: spectrum of bacterial and fungal aetiologies and their antimicrobial susceptibility patterns. BMC Infectious Diseases 2020; 20 (1): 1-11.

Raksha S, Singh G and Urhekar AD. Virulence Factors Detection in Aspergillus Isolates from Clinical and Environmental Samples. Journal of Clinical and Diagnostic Research 2017; 11 (7): 1-18.

Mimura W, Fukuda H and Akazawa M. Antimicrobial utilization and antimicrobial resistance in patients with haematological malignancies in Japan: a multi-centre cross-sectional study. Annals of Clinical Microbiology and Antimicrobials 2020; 19 (7): 1-8.

Itani M, Menias CO, Mellnick VM, El-Zakhem A, Elsayes K, Katabathina V and Revzin MV. Imaging of abdominal and pelvic infections in the cancer patient. Abdominal Radiology 2021; 46 (6): 2920-2941.

Gustinetti G. and Mikulska M. Bloodstream infections in neutropenic cancer patients: A practical update. Virulence 2016; 7 (3): 280-297.

Donnelly JP, Blijlevens NMA and van der Velden WJFM. Host Impairments in Patients with Neoplastic Diseases. In: Stosor, V, and Zembower T. R. (eds.), Infectious Complications in Cancer Patients. Cancer Treatment and Research, Vol 161. Springer International Publishing Switzerland, 2014. DOI: 10.1007/978-3-319-04220-6_1.

O'Brien SN, Blijlevens NM, Mahfouz TH, Anaissie EJ (2003) Infections in patients with hematological cancer: recent developments. Hematology Am Soc Hematol Educ Program:438–472. doi:https://doi.org/10.1182/asheducation-2003.1.438

Reed D, Sen J, Lassiter K, Thomas T, Harr E, Daniels E, Keng M (2020) Prospective. Initiative to Reduce Mucosal Barrier Injuries and Bloodstream Infections in Patients With Hematologic Malignancy Receiving Inpatient Chemotherapy. JCO Oncol Pract 16 (3):e306-e312. doi:https://doi.org/10.1200/JOP.19.00344.

Rolston KVI. (2017). Infections in Cancer Patients with Solid Tumors: A Review. Infectious Disease and Therapy, 6 : 69–83.

Zembower TR. “Epidemiology of infections in cancer patients,” Infectious Complications in Cancer Patients, vol. 161, pp. 43–89, 2014.

Bhat S, Muthunatarajan S, Mulki SS, Bhat KA. and Himani K. Bacterial Infection among Cancer Patients: Analysis of isolates and antibiotics sensitivity pattern. International Journal of Microbiology 2021; (1): 1-7.

Sullivan L. Biostatistics. Boston University School of Public Health. 2017, Power and Sample Size Determination. Available from: Sample Size Determination. Available from: https://sphweb.bumc.bu.edu/otlt/MPHModules/BS/BS704_Power/BS704Power4.html. (Accessed March 15, 2023).

GLOBOCAN (Global Cancer Observatory). (2018). Global Cancer Facts and Figures 2018; GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Last Accessed May 31st, 2022.

Clinical and Laboratory Standards Institute, (CLSI). (2017). Collection of Diagnostic Blood Specimens. 7th Edition. CLSI standard GP41. Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA.

Cheesbrough M. (2006). District Laboratory Practice in Tropical Countries. Part 2, 2nd Edition. Cambridge University Press.

Khadka S, Sherchand JB, Pokhrel BM, Parajuli K, Mishra SK, Sharma S. et al. Isolation, speciation and antifungal susceptibility testing of Candida isolates from various clinical specimens at a tertiary care hospital, Nepal. BMC Research Notes 2017; 10 (6): 218.

Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2020.

Abebaw A, Tesera H, Belachew T and Mihiretie D. The bacterial profile and antibiotic susceptibility pattern among patients with suspected bloodstream infections, Gondar, north-west Ethiopia. Pathology and Laboratory Medicine International 2018; 18 (10):1–7.

Njeru FM, Ndungu P and Bii C. Characterization and Antimicrobial Susceptibility of Actinomycetes from TB Smear Negative and Retreatment Patients in Nairobi, Kenya. Journal of Biosciences and Medicines 2019; 7 (8):1-12.

Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics. CA Cancer Journal for Clinicians 2023; 73 (1): 17‐48.

Zayas-Villanueva, OA, Campos-Acevedo, LD, Lugo-Trampe JJ, Hernández-Barajas D, González-Guerrero JF, Noriega-Iriondo MF, Ramírez-Sánchez IJ and Martínez-de-Villarreal LE. Analysis of the pathogenic variants of BRCA1 and BRCA2 using next-generation sequencing in women with familial breast cancer: a case–control study. BMC Cancer 2019; 19 (1): 722.

Akakpo PK, Imbeah EG, Eduse L, Naporo S, Ulzen‑Appiah K, Clegg‑Lamptey JN, Dedey F, Nsaful J, Affram N, Wiafe B, Mensah S, Nortey M, Sheriff M, Amponsah‑Manu F, Agbedinu K and Jiagge EM. Clinicopathologic characteristicsof early‑onset breast cancer: a comparative analysis of cases from across Ghana. BMC Women's Health 2023; 23 (5): 1-7.

Sepahi I, Faust U, Sturm M, Bosse K, Kehrer M, Heinrich T, Grundman-Hauser K, Bauer P, Ossowski S, Susak H, Varon R. et al. Investigating the effects of additional truncating variants in DNA-repair genes on breast cancer risk in BRCA1-positive women. BMC Cancer 2019; 19 (1): 787.

Chandana HB, Madhu B and Murthy MR. Awareness about cervical cancer among women residing in urban slums of Mysuru city of Karnataka, India: A cross-sectional study Clinical Epidemiology and Global Health 2020; 8 (3): 835-839.

Gebrehiwot AG, Melka DS, Kassaye YM, Gemechu T, Lako W, Hinou H and Nishimura S. Exploring serum and immunoglobulin G Nglycome as diagnostic biomarkers for early detection of breast cancer in Ethiopian women. BMC Cancer 2019; 19 (588): 1-8.

Doherty MT, Sanni OB, Coleman HG, Cardwell CR, McCluggage WG, Quinn D, et al. Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis. PLoS One 2020; 15 (4): 1-21.

Stelzle, D., Tanaka, L.F., Lee, K.K. et al. (2020) Estimates of the global burden of cervical cancer associated with HIV. Lancet Global Health. 109 (20): 30459-30469.

WHO (World Health Organization). (2020). Launch of the global strategy to accelerate the elimination of cervical cancer. WHO https://www.who.int/news-room/events/ detail/2020/11/17/default-calendar/launch-of-theglobal-strategy-to-accelerate-the-eliminationof-cervical-cancer (2020). Accessed June 25, 2021.

Svanvik T, Marcickiewicz J, Sundfeldt K, Holmberg E and Strömberg U. Sociodemographic disparities in stage-specific incidences of endometrial cancer: a registry-based study in West Sweden, 1995–2016. Acta Oncologica 2019; 58 (6): 845-851.

Muratori L, Sperone P, Gorzegno G, La Salvia A and Scagliotti GV. Systemic recurrence of endometrial cancer after 10 years of hysterectomy: a report of two cases and a brief review of the literature. Journal of the Egyptian National Cancer Institute 2020; 32 (41): 1-6.

Chen Z, Teng X, Zhang J, Huang K, Shen Q, Cao H, Luo H, Yuan Y and Teng X. Molecular features of lung adenocarcinoma in young patients. BMC Cancer 2019; 19 (1): 777.

ACS (American Cancer Society). (2020). Global Cancer Facts and Figures 2018; GLOBACAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer Journal for Clinicians. 4th, Edition. Accessed 31, May, 2022.

Nasim F, Sabath BF and Eapen GA. Lung Cancer. Medical Clinics of North America 2019; 103 (3): 463–473.

Murphy SE, Park SL, Balbo S, Haiman CA, Hatsukami DK., Patel Y, Peterson LA, Stepanov I, Stram DO et al. Tobacco biomarkers and genetic/epigenetic analysis to investigate ethnic/racial differences in lung cancer risk among smokers. NPJ Precis. Oncol. 2018; 2 (17): 1-8.

Bade BC and Dela-Cruz CS. Lung cancer Epidemiology, Etiology and Prevention. Clinical Chest Medicine 2020; 41 (1): 1–24.

Harrison S, Tilling K, Turner EL, Martin RM, Lennon R, Lane JA, Donovan JL, Hamdy FC, Neal DE, Bosch JLH and Jones HE. Systematic review and meta‑analysis of the associations between body mass index, prostate cancer, advanced prostate cancer, and prostate‑specific antigen. Cancer Causes and Control 2020; 31 (5): 431–449.

Boonhata H and Lin R-T. Association between leukemia incidence and mortality and residential petrochemical exposure: A systematic review and meta-analysis. Environment International 2020; 145 (12): 1-22.

Dong Y, Shi O, Zeng Q, Lu Q, Wang W, Li W and Wang Q. Leukemia incidence trends at the global, regional, and national level between 1990 and 2017. Experimental Hematology and Oncology 2020; 9 (14): 1-11.

Mattsson M, Sandin F, Kimby E, Höglund M, Glimelius I. Increasing prevalence of chronic lymphocytic leukemia with an estimated future rise: A nationwide population based study. American Journal of Hematology 2019; 95 (2): 36-38.

Nocini R, Molteni G, Mattiuzzi C, Lippi G. Updates on larynx cancer epidemiology. Chinese Journal of Cancer Research 2020; 32 (1): 18-25.

Aunan JR, Cho WC and Soreide K. The biology of aging and cancer: a brief overview of shared and divergent molecular hallmarks. Aging Disease 2017; 8 (5): 628–642.

IARC (International Agency for Research on Cancer). (2020). monographs on the identification of carcinogenic hazards to humans. Lyon, france: International Agency for research on Cancer. https://monographs.iarc.fr/. Accessed 25 September 2020.

GBD (Global Burden of Disease). (2020). Global and regional burden of cancer in 2016 arising from occupational exposure to selected carcinogens: a systematic analysis for the Global Burden of Disease Study 2016. Occupational and Environmental Medicine. 77: 151–159.

Schmitz, K.H., Campbell, A.M., Stuiver, M.M. et al. (2019). Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: A Cancer Journal for Clinicians, 69 (6): 468-484.

Zeng C, Wen W, Morgans AK, Pao W, Shu X-O and Zheng W. Disparities by race, age, and sex in the improvement of survival for major cancers: results from the National Cancer Institute surveillance, epidemiology, and end results (SEER) program in the United States, 1990 to 2010. JAMA Oncology 2015; 1 (1): 88-96.

Song M, Camargo, MC, Weinstein SJ, Best AF, Männistö S, Albanes D and Rabkin CS. Family history of cancer in first‑degree relatives and risk of gastric cancer and its precursors in a Western population. Gastric Cancer 2018; 21 (5):729–737.

Rumgay H, Shield K, Charvat H, Ferrari P, Sornpaisarn B, Obot I, Islami F, Lemmens VEP, Rehm J, Soerjomataram I. Global burden of cancer in 2020 attributable to alcohol consumption: A population-based study. Lancet Oncology 2021; 22 (8): 1071–1080.

Chowdhury P, Dey P, Ghosh S, Sarma A and Ghosh, U. Reduction of metastatic potential by inhibiting EGFR/Akt/p38/ERK signaling pathway and epithelial-mesenchymal transition after carbon ion exposure is potentiated by PARP-1 inhibition in nonsmall-cell lung cancer. BMC Cancer 2019; 19 (1): 829.

Meng P, Wei J, Geng Y, Chen S, Terpstra MM, Huang Q, Zhang Q, Su Z, Yu W, Su M, Kok K, Berg A and Gu J. Targeted sequencing of circulating cell-free DNA in stage II- BMC Cancer 2019; 19 (8): 818.

Surabhi G, Arti A, Pratibha K and Sarvesh Y. Pattern of bacterial infections in cancer patients: Experience from a Tertiary Cancer Center. GSC Biological and Pharmaceutical Sciences 2023; 22 (03): 210–217.

Amanati A, Sajedianfard S, Khajeh S, Ghasempour S, Mehrangiz S, Nematolahi S. and Shahhosein Z. Bloodstream infections in adult patients with malignancy, epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance. BMC Infectious Diseases 2021; 21 (636): 1-14.

Bleve A, Motta F, Durante B, Pandolfo C, Selmi C and Sica A. Immunosenescence, Inflammaging, and Frailty: Role of Myeloid Cells in Age‑Related Diseases. Clinical Reviews in Allergy and Immunology 2022; 15 (1): 1-21.

Sasaki T, Harada S, Yamamoto S, Ohkushi D, Hayama B, Takeda K. et al. Clinical characteristics of peripheral venous catheter-associated Gram-negative bloodstream infection among patients with malignancy. PLoS One, 2020; 15 (1): 1-20.

Zafer MM, El-Mahallawy HA, Abdulhak A. et al. Emergence of Colistin resistance in multidrug-resistant Klebsiella pneumoniae and Escherichia coli strains isolated from cancer patients. Annals of Clinical Microbiology and Antimicrobials, 2019; 18 (40): 1-12.

Zhu J, Wang T, Chen L and Du H. Virulence Factors in Hypervirulent Klebsiella pneumoniae. Frontiers in Microbiology 2021; 12 (4): 1-14.

Arman G, Zeyad, M, Qindah B, Taha AA, Amer R, Abutaha S, Koni AA and Zyoud SH. Frequency of microbial isolates and pattern of antimicrobial resistance in patients with hematological malignancies: a cross-sectional study from Palestine. BMC Infectious Diseases 2022; 22 (146): 1-12.

Chen CA, Ho CH, Wu YC, Chen YC, Wang JJ and Liao KM. Epidemiology of Aspergillosis in Cancer Patients in Taiwan. Infection and Drug Resistance 2022; 15 (7): 3757–3766.

Paulussen C, Hallsworth JE, Alvarez-Perez S, Nierman WC, Hamill PG, Blain D, Rediers H and Lievens B. Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species. Microbial Biotechnology 2016; 10 (2): 296-322.

Shankar J, Tiwari S, Shishodia SK, Gangwar M, Hoda S, Thakur R and Vijayaraghavan P. Molecular Insights into Development and Virulence Determinants of Aspergilli: A Proteomic Perspective. Frontiers in Cellular and Infection Microbiology 2018; 8 (18): 1-15.

Stanzani M and Lewis RE. Development and Applications of Prognostic Risk Models in the Management of Invasive Mold Disease. Journal of Fungi 2018; 4 (4): 1-14.

Pappas PG, Lionakis MS, Arendrup MC, Ostrosky-Zeichner L and Kullberg BJ. Invasive candidiasis. Disease Primers 2018; 4 (18026): 1-20.

Kojic EM and Darouiche RO. Candida Infections of Medical Devices. Clinical Microbiology Reviews 2004; 17 (2): 255–267.

Sardi JCO, Scorzoni L, Bernardi T, Fusco-Almeida AM and Giannini MJS. Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. Journal of Medical Microbiology, 2013; 62 (1): 10–24.

Richardson JP and Moyes DL. Adaptive immune responses to Candida albicans infection. Virulence 2015; 6 (4): 327—337.

Dindo M, Costanzi E, Pieroni M, Costantini C, Annunziato G, Bruno A, Keller NP, Romani L, Zelante T and Cellini B. Biochemical Characterization of Aspergillus fumigatus AroH, a Putative Aromatic Amino Acid Aminotransferase. Frontiers in Molecular Biosciences 2018; 5 (104): 1-12.

Kubecek O, Paterova P and Novosadova M. Risk factors for infections, Antibiotics Therapy, and its impact on cancer therapy outcomes for patients with solid tumors. Life (basel) 2021; 11 (12): 1-12.

Effah CY, Sun T, Liu S and Wu Y. Klebsiella pneumoniae: an increasing threat to public health. Annals of Clinical Microbiology and Antimicrobials 2020; 19 (1) : 1-5.

Gerwien F, Safyan A, Wisgott S, Brunke S, Kasper L and Hube B. The fungal pathogen Candida glabrata does not depend on surface ferric reductases for iron acquisition. Frontiers in Microbiology 2017; 8 (6): 1055.

Joudeh N, Sawafta E, Taha AA, Allah MH, Amer R, Odeh RY, Salameh H, Sabateen A, Aiesh BM and Zyoud SH. Epidemiology and source of infection in cancer patients with febrile neutropenia: an experience from a developing country. BMC Infectious Diseases, 2023; 23 (106): 1-8.

Howard KC, Dennis EK, Watt DS, Garneau-Tsodikova S. A comprehensive overview of the medicinal chemistry of antifungal drugs: perspectives and promise. Chemical Society Review 2020; 49 (8): 2426-2480.

Pfaller MA, Carvalhaes C, Messer SA, Rhomberg PR and Castanheira M. Activity of a Long-Acting Echinocandin, Rezafungin, and Comparator Antifungal Agents Tested 1 against Contemporary Invasive Fungal Isolates: SENTRY Program 2016-2018. Antimicrobial Agents Chemotherapy 2020; 64 (4): 1-20.

Published

2023-12-10

Issue

Section

ORIGINAL RESEARCH

How to Cite

1.
Microbial spectrum and susceptibility profile of opportunistic pathogens isolated from cancer patients attending a tertiary healthcare centre in Akure, Nigeria. Microbes Infect. Chemother. [Internet]. 2023 Dec. 10 [cited 2025 Apr. 27];3:e1961. Available from: https://revistas.unheval.edu.pe/index.php/mic/article/view/1961

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