Intersection of Cancer and Sepsis: Molecular Characterization of Bacterial Pathogens and Antimicrobial Resistance in Hematological Patients from Erbil, Iraq
DOI:
https://doi.org/10.15218/edj.2026.20Keywords:
hematological malignancy, Iraq, bloodstream infection, antimicrobial resistance genesAbstract
Background and Objective: Sepsis remains a leading cause of mortality in patients with hematological malignancies, particularly in settings with escalating antimicrobial resistance (AMR). This study characterized bloodstream pathogens, resistance phenotypes, and genetic determinants among septic hematological cancer patients in Erbil, Iraq.
Methods: A nine-month observational study (September 2024–March 2025) enrolled 80 patients (40 septic, 40 non-septic controls). Blood cultures were processed using the BacT/ALERT system. Antimicrobial susceptibility testing was performed using VITEK 2 Compact and Kirby–Bauer methods. Resistance genes were detected using the BioFire FilmArray BCID panel. Statistical analysis was conducted using SPSS v25 (p < 0.05).
Results: Septic patients were significantly older than controls (49.2 ± 21.5 vs. 32.8 ± 21.2 years; p = 0.0009). Gram-negative pathogens predominated (55%). Escherichia coli (22.5%) was the most frequent isolate, followed by Staphylococcus hominis (15%). Gram-positive isolates exhibited universal resistance to cefoxitin and penicillin (100%) and high resistance to oxacillin and erythromycin (88.9%), while linezolid retained 83.3% activity. Gram-negative isolates demonstrated marked resistance to cefotaxime (90.9%), ampicillin (81.8%), and imipenem (63.6%). The most prevalent resistance genes were blaCTX-M (22.7%) and NDM (9.1%) among Gram-negative isolates and mecA/mecC (11.1% each) among Gram-positive isolates.
Conclusion: The high prevalence of multidrug-resistant pathogens, including carbapenem-resistant strains, underscores the urgent need for molecular surveillance and region-specific antimicrobial stewardship in hematological oncology settings.
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