Bacterial profile, antibiotic resistance pattern and associated factors among cancer patients at University of Gondar Hospital, Northwest Ethiopia

Figures & data

Table 1 Socio-demographic characteristics of cancer patients at the University of Gondar Hospital, Northwest Ethiopia, 2017

Characteristics (n=2l6)	Frequency	Percentage
Age (years)
<25	32	14.8
25-44	74	34.3
45-64	87	40.3
>65	23	10.6
Sex
Male	80	37.0
Female	136	63.0
Educational level
No formal education	134	62.0
Primary	45	20.8
Secondary	10	4.6
Tertiary	27	12.5
Occupational status
Civil servant	28	13.0
Farmer	59	27.3
Merchant	20	9.3
Housewife	83	38.4
Others	26	12.0
Residence
Rural	111	51.4
Urban	105	48.6
Patient setting
Inpatient	78	36.1
Outpatient	138	63.9

Table 2 Clinical characteristics of cancer patients at the University of Gondar Hospital, Northwest Ethiopia, 2017

Clinical profiles	Frequency	Percentage
Type of cancer
Hematological	49	22.7
Solid	167	77.3
Specific type of cancer
Breast cancer	41	19.0
Lymphoma	34	15.7
Ovarian cyst	26	12.0
Leukemia	19	8.8
Cervical cancer	15	6.9
Colon cancer	11	5.1
Lung cancer	9	4.2
Retinoblastoma	9	4.2
Colorectal cancer	7	3.2
Others	45	20.8
Stage of cancer
Stage I	12	5.6
Stage II	19	8.8
Stage III	31	14.4
Stage IV	36	16.7
Unknown stage	118	54.6
Started cancer therapy
Yes	155	71.8
No	61	28.2
Types of cancer therapy
Chemotherapy	114	73.5
Surgery	84	54.2
Radiotherapy	3	1.9
History of catheter use
Yes	145	67.1
No	71	32.9
Febrile
Yes	23	10.6
No	193	89.4
Clinical status
Symptomatic cases	116	53.7
Asymptomatic cases	100	46.3

Table 3 Distribution of bacterial isolates from different clinical specimens among cancer patients at the University of Gondar Hospital, Northwest Ethiopia, 2017

Bacterial isolates	Clinical features
	Blood (n=23)	Urine (n=191)^a	Wound swab (n=12)	Ear discharge (n=2)	Total (%) (n=228)
Staphylococcus aureus	2	7 (21.9)	3	0	12 (28.6%)
CoNS	1	9 (28.1)	1	0	11 (26.2%)
Enterococci spp.	0	2	0	0	2 (4.8%)
Subtotal of Gram positive	3	18	4	0	25 (58.1%)
Escherichia coli	0	9 (28.1)	0	0	9 (21.4%)
Klebsiella pneumoniae	0	1	1	0	2 (4.8%)
Proteus spp.	0	2	0	1	3 (7.1%)
Citrobacter spp.	0	1	1	0	2 (4.8%)
Enterobacter spp.	0	1	0	0	1 (2.4%)
Pseudomonas aeruginosa	0	0	1	0	1 (2.4%)
Subtotal of Gram negative	0	14	3	1	18 (41.9%)
Grand total	3 (2.4%)	32 (16.8%)	7 (58.3%)	1 (50%)	43 (19.9%)

Note: ^aIncluding 100 urine sample from asymptomatic cases.

Abbreviation: CoNS, coagulase negative staphylococci.

Table 4 Antimicrobial resistance of GPB isolated from cancer patients at the University of Gondar Hospital, Northwest Ethiopia, 2017

Antimicrobial tested	GPB isolates, N (%)
	Staphylococcus aureus(n= 12)	CoNS (n = 11)	Enterococci spp. (n=2)	Total
Ciprofloxacin	1 (8.3)	5 (45.5)	1 (50.0)	7 (28.0)
Gentamycin	1 (8.3)	4 (36.4)	-	5 (21.7)
Nitrofurantoin	0	0	1 (50)	1 (5.6)
Norfloxacin	0	2 (22.2)	1 (50)	3 (16.7)
Cot-trimoxazole	5 (41.7)	5 (45.5)	-	10 (43.5)
Penicillin	7 (58.3)	10 (90.9)	1 (50)	18 (72.0)
Vancomycin	-	-	1 (50)	1 (50)
Cefoxitin	3 (25.0)	5 (45.5)	-	8 (34.8)
Tetracycline	3 (60)	1 (50)	1 (50)	5 (20.0)

Abbreviations: GPB, gram-positive bacterial; CoNS, coagulase negative staphylococci.

Table 5 Antimicrobial resistance pattern of GNB isolated from cancer patients at the University of Gondar Hospital, Northwest Ethiopia, 2017

Antimicrobial tested	GNB isolates, N (%)
	Escherichia coli	Proteus spp.	Klebsiella pneumoniae	Citrobacter spp.	Pseudomonas aeruginosa	Enterobacter spp.	Total
Ampicillin	7 (77.8)	3 (100)	2 (100.0)	2 (100.0)	—	1 (100)	15 (88.2)
Amikacine	1 (11.8)	0	0	0	0	0	1 (5.6)
AMC	8 (88.9)	2 (66.7)	2	2	—	0	14 (82.4)
Ceftriaxone	3 (33.3)	0	1	0	—	0	4 (35.5)
Ciprofloxacin	3 (33.3)	0	1	1	0	0	5 (27.8)
Gentamycin	2 (22.2)	0	2	0	1	0	5 (27.8)
Nalidixic acid	6 (66.7)	0	1	1	—	0	8 (57.1)
Nitrofurantoin	0	0	0	0	—	0	0
Norfloxacin	3 (33.3)	0	1	1	—	0	5 (35.7)
Cefepime	3 (33.3)	0	1	1	0	0	5 (27.8)
Cefixime	3 (33.3)	1 (33.3)	1	1	—	0	6 (35.3)

Abbreviations: AMC, amoxicillin/clavulonic acid; GNB, gram-negative bacterial.

Table 6 Multiple drug resistance patterns of bacteria isolated from cancer patients at the University of Gondar Hospital, Northwest Ethiopia, 2017

Bacterial isolates	Antibiogram pattern, N (%)
	R0	R1	R2	R3	R5	R6	MDR
Staphylococcus aureus	3 (25.0)	4 (33.3)	1 (8.3)	3 (25.0)	1 (8.3)	0	4 (33.3)
CoNS	0	5 (45.5)	1 (9.1)	1 (9.1)	3 (27.3)	1 (9.1)	5 (45.5)
Escherichia coli	1 (11.1)	1 (11.1)	1 (11.1)	3 (33.3)	1 (11.1)	2 (22.2)	6 (66.7)
Proteus spp.	0	1 (33.3)	1	1	0	0	1 (33.3)
Klebsiella pneumoniae	0	0	0	1	0	1	2 (100.0)
Enterococci spp.	1	0	0	0	0	1	1 (50.0)
Citrobacter spp.	0	0	1	0	1	0	1 (50.0)
Enterobacter spp.	0	1	0	0	0	0	0
Pseudomonas aeruginosa	0	1	0	0	0	0	0
Total	5 (11.6)	13 (30.2)	5 (11.6)	9 (20.9)	6 (14.0)	5 (11.6)	20 (46.5)

Note: R0: sensitive for all classes of antibiotics; R1: resistance for one class of antibiotics; R2: resistance for two classes of antibiotics; R3: resistance for three classes of antibiotics; R5: resistance for five classes; R6: resistance for six classes of antibiotics.

Abbreviations: MDR, multiple drug resistance; CoNS, coagulase negative staphylococci.

Table 7 Factors associated with culture positivity rates of cancer patients at the University of Gondar Hospital, Northwest Ethiopia, 2017

Variables		Culture result		COR (95% CI)	AOR (95% CI)	P-value
		Neg, n (%)	Pos, n (%)
Sex	Male	68 (85)	12 (15.0)	1
	Female	106 (77.9)	30 (22.1)	1.60 (0.769-3.346)
Age (years)	<25	27 (84.4)	5 (15.6)	1
	25-44	56 (75.7)	18 (24.3)	1.74 (0.582-5.173)
	45-64	72 (82.8)	15 (17.2)	1.13 (0.373-3.395)
	≥65	19 (82.6)	4 (17.4)	1.14 (0.269-4.797)
Education	No formal education	104 (77.6)	30 (22.4)	1.27 (0.443-3.636)
	Primary	40 (88.9)	5 (11.1)	0.55 (0.143-2.110)
	Secondary	8 (80.0)	2 (20.0)	1.10 (0.177-6.848)
	Tertiary	22 (81.5)	5 (18.5)	1
Occupation	Civil servant	22 (78.6)	6 (21.4)	1
	Farmer	48 (81.4)	11 (18.6)	0.84 (0.275-2.563)
	Merchant	19 (90.0)	1 (5.0)	0.19 (0.021-1.749)
	Housewife	64 (77.1)	19 (22.9)	1.09 (0.386-3.073)
	Others	22 (84.6)	4 (15.4)	0.87 (0.231-3.297)
Residence	Rural	87 (78.4)	21 (24.6)	1.33 (0.676-2.631)
	Urban	87 (82.9)	18 (17.1)	1
Patient setting	Inpatient	59 (75.6)	19 (24.4)	1.61 (0.813-3.19!)	1.52 (0.710-3.266)	0.280
	Outpatient	115 (83.3)	23 (16.7)	1	1
Type of cancer	Hematological	45 (91.8)	4 (8.2)	1	1
	Solid	129 (77.2)	38 (22.8)	3.31 (1.l20-9.805)^a	3.19 (l.026-9.882)^b	0.045
Stage of cancer	I	10 (83.3)	2 (16.7)	1
	II	16 (84.2)	3 (15.8)	0.94 (0.133-6.628)
	III	26 (83.9)	5 (16.1)	0.96 (0.160-5.786)
	IV	26 (72.2)	10 (27.8)	1.92 (0.357-10.363)
	Unknown stage	96 (81.4)	22 (18.6)	1.15 (0.234-5.604)
Hospital admission	No	23 (92.0)	2 (8.0)	1	1
	Yes	151 (79.1)	40 (20.9)	3.05 (0.689-13.468)	1.24 (0.221-6.915)	0.810
Cancer treatment	Yes	119 (76.3)	36 (23.2)	2.77 (1.104—6.969)^a	3.38 (l.286-8.882)^b	0.014
	No	55 (90.2)	6 (9.8)	1	1
Catheter use	Yes	110 (75.9)	35 (24.1)	2.91 (1.221-6.930)^a	2.04 (0.747-5.580)	0.164
	No	64 (90.1)	7 (9.9)	1	1
Symptomatic for	No	94 (94.0)	6 (6.0)	1	1
infection	Yes	80 (69.0)	36 (31.0)	7.05 (2.826-17.589)^a	7.85 (3.086-19.980)^b	0.001
Neutrophil count	<4,000	84 (84.0)	16 (16.0)	1.71 (0.203-14.484)
(cells/μ L)	4,000-11,000	81 (76.4)	25 (23.6)	2.78 (0.335-23.006)
	>11,000	9 (90.0)	1 (10.0)	1

Notes: ^aAssociated factors in bivariate logistic regression analysis.

b Associated factors in multivariate logistic regression analysis.

Abbreviations: Neg, negative; Pos, positive.