الفهرس 
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Abstract
Cancer patients are more susceptible to bacterial and fungal infections which increase the mortality rate among them. The type, severity and treatment of infections vary and depend on several factors including the malignancy type, associated chemotherapies and transplantation. Cancer patients are more susceptible to Health care associated infections (HCAIs) particularly those in intensive care units or undergoing surgical intervention. Although the usage of empirical antibiotics is necessary in cancer patients due to their weakened immune system, antibiotic use among these patients has led to the emergence of multidrug-resistant bacteria. So, the aim of this study was to identify the different pathogens isolated from infected patients with solid organ tumors and hematological malignancies with evaluation of the anti-microbial susceptibility pattern of bacterial isolates, correlate between the results of antibiotic sensitivity and empirical antibiotics used to improve infection outcome in cancer patients also, correlate between types of infection, underlying cancer disease and type of treatment given to patients. The present study was carried out in Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University during the period from January 2023 to January 2024. The study carried on 228 samples collected from patients with symptoms and signs of infection, including the inpatients and outpatients, in Clinical Oncology department, Tanta University Hospitals. Different samples from different sites were withdrawn aseptically from patients with signs and symptoms of infection. All samples were subjected to bacteriological and fungal examination including isolation and identification of different Gram-positive and negative bacteria and fungi using routine standard methods, antimicrobial susceptibility tests using the disc diffusion method according to the CLSI guidelines. ESBL detection among isolated Gram-negative bacteria was done by modified double disk synergy test. Also, meropenem was used to test CR in isolated Gram-negative bacteria. Blood cultures were incubated in automated blood culture system BACTEC FX40. Positive alert for automated blood cultures were processed in a manner like conventional blood culture system by subculturing. Render MA120 was used to identify pathogens that could not be identified using conventional methods and detect MIC for Vancomycin and Colistin in bacterial isolates. In this study, female patients were more than male patients and the majority of patients were between 41-60 years old (45.6%). Patients had solid tumors represented (55.3%) while (44.7%) had hematological malignancies and about 38 % of cases had metastasis. Moreover (46.1%) patients were admitted to the hospital for variable periods of time with (36.4%) of patients having different types of inserted medical devices. This study showed that (46.5%) of patients had comorbidity. Also 24.1% and 64% of the patients were presented with neutropenia and fever respectively. Additionally, (64%) of patients did not receive any empirical antibiotic therapy. In this study, urogenital infections represented (20.2%), followed by blood stream infections (BSIs) (16.2%) and respiratory tract infections (12.7%). Most of the samples yielded single pathogen (48.7%) with predominance of Gram-negative bacteria (46%). Patient hospitalization and presence of inserted medical devices and fever showed a statistical significance with positive culture results. Urinary tract infections were statistically significant with patients not receiving cancer therapy and empirical antibiotic treatment, hospital stay and absence of inserted medical devices, in contrast, wound related and surgical site infections were correlated significantly with solid tumors, patients receiving cancer treatment and empirical antibiotic treatment and presence of inserted medical devices. The most frequently isolated pathogen was Escherichia coli (E coli), followed by klebsiella pneumoniae (K. pneumoniae) and Staphylococcus aureus (Staph. aureus). While Candida albicans represented the majority of fungal infection in this study. Also, Aspergillus spp. was isolated from respiratory samples only. Regarding anaerobic infections, 2 of Clostridium perfringens were isolated from cancer patients. All Gram-negative isolates were resistant to Ampicillin and Amoxicillin-Clavulanic, and most of these bacteria were sensitive to colistin and meropenem. All Gram-positive isolated strains were resistance to Penicillin (100%) whereas the least resistance rate was against Linezolid as all CONS and Enterococci spp. strains were sensitive and (3.2%) of Staph. aureus was resistant to Linezolid. In this study, out of 120 isolated Gram-negative bacteria, 20 (16.7%) were Extended Spectrum Beta Lactamase (ESBL) producers. Out of 177 isolated, 111 were MDROs with predominance of E. coli, K. pneumoniae and Staph. aureus with 22.5%, 21.6% and 20.7% respectively. K. pneumoniae represented the majority of PDROs with 44.4%. Among isolates, Carbapenem resistance (CR) represented (27.1%) followed by MRSA and ESBL (13%) and (11.3%) of total isolates respectively. In the current study, the majority of patients received an inappropriate empirical antibiotic with (57.3%) invitro resistance. Regarding death rate among cancer patients, prolonged hospital stays and presence of different type of medical devices were associated with high mortality rate and the results were statistically significant. Moreover, patients receiving empirical antibiotics therapy along with those with Gram-negative bacterial infections demonstrated higher correlation with increased mortality rate.