Microbiological Identification of Bacteria with Leukemic Children

The most common form of childhood cancer is leukemia, Calculation for more than one third of all childhood cancers among those ages 1 day – 14 years. The diseases of leukemia are worldwide, it occurred in both genders from male and females and in all age. A total of 80 different samples of patient children were collected from the central teaching hospital of pediatric in Baghdad. Obtained during the period from 1st Sept. 2019 till the 31 th of Aug. 2020. Each isolates identification by using Vitek 2. Isolated organism in leukemic children show 18 (22.5 %) gram positive and 62 (77.5 %) gram negative from the total sample 80 (100.0 %). The percent of male is 45 more than female which represents 35 in most age groups between age (1 day-3 year) 33 (100.0 %). In most distribution of organism according to the type of sample for gram positive is Staphylococcus aureus 13 (16.2 %) and gram negative Escherichia coli 21 (26.3 %), Klebsiella pneumoniae 13 (16.2 %), Pseudomonas aeruginosa 11 (13.8 %) from the total results 80 (100.0 %). In Conclusion, the gram negative bacteria is more than gram positive bacteria and especially effect with Escherichia coli, and Staphylococcus aureus , in males for the age group 1 day to 3 years. And the most antibiotic sensitive to Escherichia coli is Imipenem, Amikacin, Gentamycin, Piperacillin/Tazobactam and resist to Cefotazidime, Tobramycin, Cefepime, Ceftriaxone, Ciprofloxacin and Staphylococcus aureus most sensitive to Vancomycin, Gentamycin, Clindamycin, and resist to Penicillin, Cefotaxime , Ceftriaxone, Oxacillin.


iNtROduCtiON
The most common form of childhood cancer is leukemia, Calculation for more than one third of all childhood cancers among those ages 1 day -14 years. 1 The diseases of leukemia are worldwide, it occurred in both genders from male and females and in all age. 2 Determined the clinical presentations of infections through a complex interaction between the virulence, pathogen, and the defense mechanisms of the host and the degree to impaired. 3Patients with previously untreatable illness may now receive therapy and survive, due to large advances have been done in the management of patients with cancers. 4Most important reasons for morbidity and mortality in leukemia is bacterial infections. 5A divers set of chromosomal and molecular changes originate in pediatric leukemia, most of proof are acquired not inherited as only 5% of leukemia are associated with inherited syndromes. 6Leukemic relapses in the early decades of therapy for childhood acute lymphoblastic leukemia (ALL) was recognized in central nervous system. 7In patient who receives cancer treatment, blood stream infection is one of the major causes of morbidity and mortality. 80][11] Although evolution in antibiotics therapy, it remain the basic reason for mortalities in hospitalized patients chiefly critically ill patients like leukemia patients. 12n acute medical condition the semi-pathogen and normal microflora organisms can play important role. 13Higher mortality associated with polymicrobial was found 15-25% of bacteremia infections in cancer patients. 8Fever during chemotherapy induce neutropenia can be the first sign of bacterial infection. 14The neutropenic patients developing fever during neutropenia is a recurrent complication, Affecting 80% of those with hematological malignancies. 15In cancer patients for the choice of an effective empirical therapy or prophylaxis the important result is to increase of resistant bacteria. 16,17Excessive antibiotic exposure is also the most important agents influencing the emergence and prevalence of antibiotic resistance. 18

MethOds
A total of 80 different samples of patient children were collected from the central teaching hospital of pediatric in Baghdad.Obtained during the period from 1 st Sept. 2019 till the 31 st of Aug. 2020.Data was collected by using questionnaire sheet concerning their [ages from (1 days -15 years), sex, type of sample, diagnosis and antibiotic sensitivity.
The identification of each isolates by using the Vitek 2 which is automated microbiology system and its applications.The reagent cards used that are incubated and expound automatically.The Vitek 2 system was used according to the manufacturer's instructions; The combination of automated Vitek 2 Technology ready-to-use Vitek 2 identification (ID) and susceptibility (AST) cards provide dependable, accurate ID and AST results for clinically important Gram-positive cocci, Gram-negative cocci, Gram-positive bacilli, Gram-negative bacilli.The sample was culture on special media according to the type of sample on blood agar, MacConkey agar, Chocolate agar and incubated at 35-37°C at 18-24 hours, bacteria were suspend in 2.5 ml of 0.45% sodium chloride solution.The suspension used in the Vitek2 system was adjusted to a McFarland standard of 0.5 by using a Densicheek (bioMerieux).

Statistical Analysis
Used in order that analyze and assess the results they including: Binomial (0.50) = Frequencies /Descriptive statistics Descriptive statistics statistical tables contain observed frequencies with their percentages.

Inferential statistics
The accept or reject show by used statistical hypotheses, 0.05 level of significance represent the Persons Chi-Square test (χ2).
P value < 0.05 level of significance was considered statistically significant.P-value < 0.025 in 2-sided.

Table 2 .
Age and Sex Distribution in Leukemic Children P-Value > 0.025 in 2-sided.

Table 1 .
Isolated Organism in Leukemic Children

Table 3 .
The Distribution of Organism according to the type of Sample

Table 5 .
Antimicrobial Susceptibility Pattern of Isolated Gram Negative Bacteria