• Rdhwan Shukr Uso Department of Basic Sciences (Microbiology Unit) College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
  • Chato Ali Taher Department of Basic Sciences (Microbiology Unit) College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq
Keywords: Bacterial profile, antibiotic resistance pattern, Hematological malignancy


Background and Objectives: Cancer are one of the major global health problems, patients with hematological malignancies are highly susceptible to almost any type of bacteria. In this study, we aimed to determine the bacterial profile, antimicrobial resistance pattern, and associated factors among patients with hematological malignancies.

Method: A consecutive 70 hematological malignancies patients were enrolled from January to October, 2020; at Nanakaly hospital for blood disease and cancer in Erbil- Kurdistan region. Clinical data and Socio-demographic were collected by a structured questionnaire. Culture and antibiotic resistance were performed following standard microbiological procedures.

Result: The incidence of bacterial infection among examined cancer patients were 62.8 % (44/70). E.coli was among the predominant bacterial isolates (20%), followed by Klebsiella pneumoniae (11%), Streptococcus parasnguinis, and Staphylococcus haemolyticus (9%). These bacterial isolates were resistant to different antibiotics. Gram- negative bacteria were highly resistant to several antibiotics including, ciprofloxacin, gentamycin, sulfamethoxazole/trimethoprim, piperacillin, and cefepime, but they were sensitive to imipenem, amikacin and tigecycline. While gram-positive bacteria were highly resistant to tetracycline, ceftriaxone, levofloxacin, ampicillin, and erythromycin, but they were highly sensitive to linezolid, tigecycline, imipenem and vancomycin. The majority of resistance organism against fluoroquinolone were E.coli (72.7%) followed by Klebsiella pneumoniae (66.7%). Among gram-positive bacteria Streptococcus parasnguinis was highly resistance while sensitive organisms were Staphylococcus aureus, CoNS, viridance streptococcus and Enterococcus faecalis.

Conclusion: Among hematological malignant patients, the majority of patients were diagnosed as acute leukemia, gram-negative bacteria were more frequently isolates comparing with gram- positive bacteria. E coli was among predominant pathogen followed by Klebsiella pneumoniae, Streptococcus parasnguinis and Staphylococcus haemolyticus.


Download data is not yet available.


ABDOLLAHI, A., HAKIMI, F., DOOMANLOU, M. & AZADEGAN, A. 2016. Microbial and Antibiotic Susceptibility Profile among Clinical Samples of Patients with Acute Leukemia. International Journal of Hematology-Oncology and Stem Cell Research, 10, 61-69.
ADIPOCYTES, O. S. M. T. 2014. BASIC SCIENCES UPDATES. The Medical-Surgical Journal, 118.
AL-HASAN, A. R. 2013. Study of carbapenem resistance in Acinetobacter baumannii isolates from Kuwait.
AL-ZUBAIDY, A. S., JUMAAH, S. S. & RADHI, Q. R. 2020. Bacteriological Study of Febrile Neutropenia in Patients with Hematological Malignancies in Baghdad Teaching Hospital. IRAQI POSTGRADUATE MEDICAL JOURNAL, 19.
ALCALA-GUANZON, M. & TAN-TORRES, T. 1998. Outcom of Bacteremia at the Philippine General Hospital. Phil J Microbiol Infect Dis, 27, 103-8.
ALMAZINY, M. A. 2014. Isolation, identification, and profile of antibiotic resistance of bacteria in childhood febrile neutropenia patients. Eur J Exp Biol, 4, 1-6.
ANDERSON, R., GROUNDWATER, P. W., TODD, A. & WORSLEY, A. 2012. Antibacterial Agents: Chemistry, Mode of Action, Mechanisms of Resistance and Clinical Applications, John Wiley & Sons.
ASHOUR, H. M. & EL-SHARIF, A. 2009. Species distribution and antimicrobial susceptibility of gram-negative aerobic bacteria in hospitalized cancer patients. Journal of translational medicine, 7, 14.
ATLAS, R. M. 2010. Handbook of Microbiological Media, CRC Press.
ATLAS, R. M., BROWN, A. E. & PARKS, L. C. 1995. Laboratory manual of experimental microbiology, Mosby.
AZOULAY, É. & SCHLEMMER, B. 2006. Diagnostic strategy in cancer patients with acute respiratory failure. Intensive care medicine, 32, 808-822.
BARTLETT, J. G. & FINEGOLD, S. M. 1978. Bacteriology of Expectorated Sputum with Quantitative Culture and Wash Technique Compared to Transtracheal Aspirates. American Review of Respiratory Disease, 117, 1019-1027.
BASKARAN, N. D., GAN, G. G., ADEEBA, K. & SAM, I. C. 2007. Bacteremia in patients with febrile neutropenia after chemotherapy at a university medical center in Malaysia. International Journal of Infectious Diseases, 11, 513-517.
BIEHL, L. M., SCHMIDT-HIEBER, M., LISS, B., CORNELY, O. A. & VEHRESCHILD, M. J. 2016. Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients–review of the literature from a clinical perspective. Critical reviews in microbiology, 42, 1-16.
BOERLIN, P., KUHNERT, P., HÜSSY, D. & SCHAELLIBAUM, M. 2003. Methods for identification of Staphylococcus aureus isolates in cases of bovine mastitis. Journal of clinical microbiology, 41, 767-771.
BRAY, F., FERLAY, J., SOERJOMATARAM, I., SIEGEL, R. L., TORRE, L. A. & JEMAL, A. 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68, 394-424.
BROWNSON, R. C., NOVOTNY, T. E. & PERRY, M. C. 1993. Cigarette smoking and adult leukemia: a meta-analysis. Archives of internal medicine, 153, 469-475.
CALFEE, D. P. & FARR, B. M. 2002. Comparison of four antiseptic preparations for skin in the prevention of contamination of percutaneously drawn blood cultures: a randomized trial. Journal of clinical microbiology, 40, 1660-1665.
CHIU, S.-K. & CHANG, F.-Y. 2009. Pyomyositis caused by extended-spectrum β-lactamase-producing Escherichia coli in a patient with acute myeloid leukemia. International Journal of Infectious Diseases, 13, e85-e87.
DHEYAB, A. S., ALJUMAILI, O. I. & HUSSEIN, N. M. 2018. Study of Virulence Factors in Urease-Positive Bacteria Isolated from Urinary Tract Infections Clinical Specimens. Journal of PurE and aPPliEd Microbiology, 12, 1465-1472.
DOERN, C. D., MIRRETT, S., HALSTEAD, D., ABID, J., OKADA, P. & RELLER, L. B. 2014. Controlled clinical comparison of new pediatric medium with adsorbent polymeric beads (PF Plus) versus charcoal-containing PF medium in the BacT/Alert blood culture system. Journal of clinical microbiology, 52, 1898-1900.
EL HADDAD, H., CHAFTARI, A.-M., HACHEM, R., CHAFTARI, P. & RAAD, I. I. 2018. Biomarkers of sepsis and bloodstream infections: the role of procalcitonin and proadrenomedullin with emphasis in patients with cancer. Clinical Infectious Diseases, 67, 971-977.
ELMANAMA, A. A., AL LAHAM, N. A. & TAYH, G. A. 2013. Antimicrobial susceptibility of bacterial isolates from burn units in Gaza. Burns, 39, 1612-1618.
ESLAMI NEJAD, Z., GHAFOURI, E., FARAHMANDI-NIA, Z., KALANTARI, B. & SAFFARI, F. 2010. Isolation, identification, and profile of antibiotic resistance of bacteria in patients with cancer. Iranian Journal of Medical Sciences, 35, 109-115.
FENTIE, A., WONDIMENEH, Y., BALCHA, A., AMSALU, A. & ADANKIE, B. 2018a. Bacterial profile, antibiotic resistance pattern and associated factors among cancer patients at University of Gondar Hospital, Northwest Ethiopia. Infection and Drug Resistance, Volume 11, 2169-2178.
FENTIE, A., WONDIMENEH, Y., BALCHA, A., AMSALU, A. & ADANKIE, B. T. 2018b. Bacterial profile, antibiotic resistance pattern and associated factors among cancer patients at University of Gondar Hospital, Northwest Ethiopia. Infection and drug resistance, 11, 2169.
FERLAY, J., SOERJOMATARAM, I., DIKSHIT, R., ESER, S., MATHERS, C., REBELO, M., PARKIN, D. M., FORMAN, D. & BRAY, F. 2015. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer, 136, E359-E386.
FORBES, B. A., SAHM, D. F. & WEISSFELD, A. S. 2007. Diagnostic microbiology, Mosby St Louis.
GE, Z. & TAYLOR, D. E. 1997. Methods in molecular medicine, Helicobacter pylori protocols.
GHOSH, I., RAINA, V., KUMAR, L., SHARMA, A., BAKHSHI, S., THULKAR, S. & KAPIL, A. 2012. Profile of infections and outcome in high-risk febrile neutropenia: experience from a tertiary care cancer center in India. Medical Oncology, 29, 1354-1360.
GOLDMAN, E. & GREEN, L. H. 2015. Practical handbook of microbiology, CRC press.
GRAFFUNDER, E. M., PRESTON, K. E., EVANS, A. M. & VENEZIA, R. A. 2005. Risk factors associated with extended-spectrum β-lactamase-producing organisms at a tertiary care hospital. Journal of Antimicrobial Chemotherapy, 56, 139-145.
GRASGRUBER, P., HRAZDIRA, E., SEBERA, M. & KALINA, T. 2018. Cancer incidence in Europe: an ecological analysis of nutritional and other environmental factors. Frontiers in oncology, 8, 151.
GUDIOL, C., BODRO, M., SIMONETTI, A., TUBAU, F., GONZÁLEZ-BARCA, E., CISNAL, M., DOMINGO-DOMENECH, E., JIMÉNEZ, L. & CARRATALÀ, J. 2013. Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Clinical Microbiology and Infection, 19, 474-479.
GUPTA, N., PAWAR, R., BANERJEE, S., BRAHMA, S., RATH, A., SHEWALE, S., PARIHAR, M., SINGH, M., ARUN, S. R. & KRISHNAN, S. 2019. Spectrum and immunophenotypic profile of acute leukemia: a tertiary center flow cytometry experience. Mediterranean Journal of Hematology and Infectious Diseases, 11.
HOHEISEL, G., LANGE, S., WINKLER, J., RODLOFF, A. C., LIEBERT, U. G., NIEDERWIESER, D., SCHAUER, J. & ENGELMANN, L. 2003. Nosocomial pneumonias in haematological malignancies in the medical intensive care unit. Pneumologie (Stuttgart, Germany), 57, 73-77.
IRVING, W., BOSWELL, T. & ALA'ALDEEN, D. 2004. BIOS Instant Notes in Medical Microbiology, Taylor & Francis.
KANAMARU, A. & TATSUMI, Y. 2004. Microbiological data for patients with febrile neutropenia. Clinical infectious diseases, 39, S7-S10.
KASIM, K., LEVALLOIS, P., ABDOUS, B., AUGER, P. & JOHNSON, K. C. 2005. Lifestyle factors and the risk of adult leukemia in Canada. Cancer Causes & Control, 16, 489-500.
KIM, H.-I., LIM, H. & MOON, A. 2018. Sex Differences in Cancer: Epidemiology, Genetics and Therapy. Biomolecules & Therapeutics, 26, 335-342.
KLINE, K. A. & LEWIS, A. L. 2017. Gram-positive uropathogens, polymicrobial urinary tract infection, and the emerging microbiota of the urinary tract. Urinary Tract Infections: Molecular Pathogenesis and Clinical Management, 459-502.
KOKKAYIL, P., AGARWAL, R., MOHAPATRA, S., BAKSHI, S., DAS, B., SOOD, S., DHAWAN, B. & KAPIL, A. 2018. Bacterial profile and antibiogram of blood stream infections in febrile neutropenic patients with haematological malignancies. The Journal of Infection in Developing Countries, 12, 442-447.
KONEMAN, E. W., ALLEN, S. D., JANDA, W. M., SCHRECKENBERGER, P. C. & WINN, W. C. 1997. Diagnostic microbiology. The nonfermentative gram-negative bacilli. Philedelphia: Lippincott-Raven Publishers, 253-320.
LAGIER, D., PLATON, L., CHOW-CHINE, L., SANNINI, A., BISBAL, M., BRUN, J. P., BLACHE, J. L., FAUCHER, M. & MOKART, D. 2016. Severity of Acute Respiratory Distress Syndrome in haematology patients: long-term impact and early predictive factors. Anaesthesia, 71, 1081-1090.
LEBEA, M. M. & DAVIES, V. 2017. Evaluation of culture-proven neonatal sepsis at a tertiary care hospital in Johannesburg, South Africa. South African Journal of Child Health, 11, 170-173.
LITTLE, J. R., MURRAY, P. R., TRAYNOR, P. S. & SPITZNAGEL, E. 1999. A randomized trial of povidone-iodine compared with iodine tincture for venipuncture site disinfection: effects on rates of blood culture contamination. The American journal of medicine, 107, 119-125.
MARIN, M., GUDIOL, C., ARDANUY, C., GARCIA-VIDAL, C., CALVO, M., ARNAN, M. & CARRATALÀ, J. 2014. Bloodstream infections in neutropenic patients with cancer: differences between patients with haematological malignancies and solid tumours. Journal of Infection, 69, 417-423.
MASHHADI, M. A., ZAKERI, Z. & ABDOLLAHINEJAD, M. J. 2010. Cancer incidence in South East of Iran: results of a population-based cancer registry.
MATHUR, P., CHAUDHRY, R., KUMAR, L., KAPIL, A. & DHAWAN, B. 2002. A study of bacteremia in febrile neutropenic patients at a tertiary-care hospital with special reference to anaerobes. Medical Oncology, 19, 267-272.
MCKANE, L. & JUDI, K. 1996. Microbiology Essentials and Applications, McGrow-Hill. Inc. USA, 787-809.
MEIDANI, M., BAGHERI, A. & KHORVASH, F. 2013. A population-based study of bacterial spectrum in febrile neutropenic patients.
NURAIN, A. M., BILAL, N. E. & IBRAHIM, M. E. 2015. The frequency and antimicrobial resistance patterns of nosocomial pathogens recovered from cancer patients and hospital environments. Asian Pacific Journal of Tropical Biomedicine, 5, 1055-1059.
PACHAURI, S., VARSHNEY, P., DASH, S. K. & GUPTA, M. K. 2013. Involvement of fungal species in bovine mastitis in and around Mathura, India. Vet World, 6, 393-395.
PANDOLFI, D. & PONS, M.-N. L. 2004. Gram-staining characterisation of activated sludge filamentous bacteria by automated colour analysis. Biotechnology Letters, 26, 1841-1846.
PATEL, J. B., COCKERILL, F. R. & BRADFORD, P. A. 2015. Performance standards for antimicrobial susceptibility testing: twenty-fifth informational supplement.
PINCUS, D. H. 2006. Microbial identification using the bioMérieux Vitek® 2 system. Encyclopedia of rapid microbiological methods, 1, 1-32.
QIN, T., MI, Y., FENG, S., LI, D., WEI, J., YANG, D., HAN, M., WANG, J. & BIAN, S. 2007. Clinical study on fluoroquinolone prophylaxis in neutropenia patients with acute leukemia. Zhonghua yi xue za zhi, 87, 1389-1393.
RASMY, A., AMAL, A., FOTIH, S. & SELWI, W. 2016. Febrile neutropenia in cancer patient: epidemiology, microbiology, pathophysiology and management. J Cancer Prev Curr Res, 5, 00165.
SAGHIR, S., FAIZ, M., SALEEM, M., YOUNUS, A. & AZIZ, H. 2009. Characterization and anti-microbial susceptibility of gram-negative bacteria isolated from bloodstream infections of cancer patients on chemotherapy in Pakistan. Indian journal of medical microbiology, 27, 341.
SHARMA, U., SCHWAN, W. R. & AGGER, W. A. 2011. Escherichia coli pyomyositis in an immunocompromised host. WMJ: official publication of the State Medical Society of Wisconsin, 110, 182.
TANG, Y., WU, X., CHENG, Q. & LI, X. 2020. Inappropriate initial antimicrobial therapy for hematological malignancies patients with Gram-negative bloodstream infections. Infection, 48, 109-116.
TSUTSUI, A. & SUZUKI, S. 2018. Japan nosocomial infections surveillance (JANIS): a model of sustainable national antimicrobial resistance surveillance based on hospital diagnostic microbiology laboratories. BMC health services research, 18, 799.
UGAI, T., MATSUO, K., SAWADA, N., IWASAKI, M., YAMAJI, T., SHIMAZU, T., SASAZUKI, S., INOUE, M., TSUGANE, S. & GROUP, J. P. H. C.-B. P. S. 2017. Smoking and subsequent risk of leukemia in Japan: the Japan public health center-based prospective study. Journal of Epidemiology, 27, 305-310.
VANDEPITTE, J., VERHAEGEN, J., ENGBAEK, K., ROHNER, P., PIOT, P., HEUCK, C. C. & HEUCK, C. C. 2003. Basic laboratory procedures in clinical bacteriology, World Health Organization.
VENTO, S. & CAINELLI, F. 2003. Infections in patients with cancer undergoing chemotherapy: aetiology, prevention, and treatment. The lancet oncology, 4, 595-604.
VERSPORTEN, A., ZARB, P., CANIAUX, I., GROS, M.-F., DRAPIER, N., MILLER, M., JARLIER, V., NATHWANI, D., GOOSSENS, H. & KORAQI, A. 2018. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. The Lancet Global Health, 6, e619-e629.
WEINSTEIN, R. A. 2001. Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics. Emerging infectious diseases, 7, 188.
YAO, J.-F., LI, N. & JIANG, J. 2017. Clinical characteristics of bloodstream infections in pediatric acute leukemia: A single-center experience with 231 patients. Chinese medical journal, 130, 2076.
How to Cite
Uso, R. and Ali Taher, C. (2021) “BACTERIAL PROFILE, ANTIBIOTIC RESISTANCE PATTERNS, AND ASSOCIATED FACTORS AMONG HEMATOLOGICAL MALIGNANT PATIENTS IN ERBIL CITY”, Zanco Journal of Pure and Applied Sciences, 33(3), pp. 70-84. doi: 10.21271/ZJPAS.33.3.8.
Biology and Medical Researches