Bacterial infections in cancer patients at Benghazi Medical Center, Libya: epidemiology and antimicrobial resistance
Abstract
Background: Cancer patients are highly susceptible to bacterial infections due to immunosuppression from malignancy and treatment, which significantly increases morbidity, mortality, and hospital stays.Methods: A retrospective observational study was conducted at Benghazi Medical Center, Libya, between January 2023 and December 2024. Clinical specimens from 188 cancer patients with confirmed infections were processed using the VITEK 2 system, and antimicrobial susceptibility was interpreted according to CLSI standards.Results: A total of 227 bacterial isolates were recovered: 159 (70.0%) Gram-negative and 68 (30.0%) Gram-positive. The most common Gram-negative pathogens were Klebsiella spp. (31.4%), Pseudomonas aeruginosa (25.2%), and Escherichia coli (23.9%), while Staphylococcus aureus constituted 48.5% of Gram-positive isolates. Bloodstream infections were the most frequent (36.7%), followed by respiratory tract infections (27.1%) and urinary tract infections (17.6%). Solid tumor patients had more bloodstream infections (38.9%), while respiratory infections were slightly more common in hematologic malignancy patients (27.0%). ESBL production was observed in 52.0% of Klebsiella spp. and 50.0% of E. coli. Methicillin-resistant S. aureus (MRSA) accounted for 39.4% of isolates, with all Gram-positive isolates remaining susceptible to vancomycin. The overall mortality was 40.0%, with Neutropenia significantly associated with poor outcomes. Conclusion: Multidrug-resistant bacterial infections, particularly ESBL-producing Gram-negative organisms and MRSA, are prevalent among cancer patients in Libya. Strengthened infection control, antimicrobial stewardship, and targeted empirical therapy are crucial to reduce morbidity and mortality.
References
Afolayan AO, Olalekan AO, Aboderin AO. Bacterial infection patterns among oncology patients in low-income countries: a systematic review. Infect Prev Pract. 2024;6(1):100310.
Akhreim, A. A., Gaballa, M. F., Sulaiman, G., & Attitalla, I. H. (2024). Biofertilizers production and climate changes on environmental prospective applications for some nanoparticles produced from some microbial isolates. International Journal of Agriculture and Biosciences, 13(2), 196-203.
Al Awwa IA, Tayseer M, Abu-Rub A, Al-Omari A, Al-Hussaini M, Almasri M, et al. Investigation of antimicrobial susceptibility patterns, risk factors and their impact on mortality in cancer patients at a tertiary care cancer hospital. Ann Clin Microbiol Antimicrob. 2024;23(1):1–10.
Al-Haddad A, Ben Faleh A, Amri R. Resistance trends in Gram-positive cocci (MRSA, VRE) among immunocompromised patients in the Mediterranean region. Mediterr J Hematol Infect Dis. 2025;17(1):e2025010.
Chen CY, Hsu SC, Lai CC. Pneumonia and non-respiratory infections in solid tumor patients: incidence and mortality patterns. BMC Infect Dis. 2023;23(1):1154.
DiNardo CD, Pratz K, Pullarkat V. Infection-related mortality in hematologic malignancies: contemporary global patterns. Blood Adv. 2024;8(2):355–364.
Elhafi, G. E., Gaballa, M. F., Attitalla, I. H., Albakush, S. A., & Albackoosh, M. A. (2024). Examining the Health Benefits of Olive Oil: A Review Tailored to the Libyan Setting. GPH-International Journal of Biological & Medicine Science, 7(04), 14-23.
El-Mahallawy HA, Sherief LM, Hassan SS. Infection trends in cancer patients in developing countries: a 10-year update. J Glob Oncol. 2023;9:1–12.
Freifeld AG, Bow EJ, Sepkowitz KA. Microbiological epidemiology of infections in high-income cancer centers: evolving Gram-positive predominance. J Clin Oncol. 2023;41(9):1543–1554.
Gaballa, M. F. (2017). Chromobacterium Violaceum strains growth conditions impacting N-Acyl Homoserine Lactones AHL production. Tennessee State University.
Gaballa, M., Soutiyah, M., Abid, A., & Attitalla, I. (2025). Distribution, Abundance, and Environmental Responses of Actinobacteria in Rhizospheric and Bulk Soils of Al-Haniya, Libya. In Acta Biology Forum.
Hassan, M. Y. A., Gaballa, M. F., ZIDAN, M. E. K., Abid, A. A. D., Attitalla, I. H., Bansal, S., ... & Tien, N. H. T. (2025). Lactobacillus Probiotics: Mechanisms, Health Benefits, and Applications in Combating Pathogenic Bacteria. International Journal of Medical and All Body Health Research, 6(3), 208-216.
Hoenigl M, Prattes J, Thornton C. Predictors of mortality in MDR bacterial infections among oncology patients. Clin Microbiol Infect. 2024;30(3):319–327.
Jajarm HH, Farajzadeh Sheikh A, Rezai MS. Multidrug-resistant Gram-negative bacteria in oncology patients: ESBL and carbapenem resistance burden. Antimicrob Resist Infect Control. 2024;13(1):24.
Kamboj M, Sepkowitz KA. Risk factors for infection and mortality in cancer patients with neutropenia. Clin Infect Dis. 2023;76(4):e1054–e1062.
Kamboj M, Sun J, Velazquez L. Bloodstream infections in hematologic malignancies: updated epidemiology and outcomes. Lancet Haematol. 2024;11(5):e230–e242.
Khalil, M. M., Gaballa, M. F., Sulaiman, G., & Attitalla, I. H. (2024). Epidemiological assessment of the burden and determinants of methicillin-resistant Staphylococcus aureus (MRSA) infections in wounds. Int. J. Bio. & Medic. Science, 7(05), 39-50.
Khalil, M. M., Sulaiman, G., Gaballa, M. F., & Attitalla, I. H. Investigation of bacterial flora on mobile phones: A comparative study between healthcare workers and non-healthcare workers. Journal Name, 24, 1-7.
Liu C, Wang Y, Li X, Zhang H, Xu X, Chen L, et al. Bacterial co-infections and antimicrobial resistance in cancer patients with COVID-19: predictors and clinical impact. Microb Pathog. 2023;182:106168.
Mahmoud, R., Gaballa, M., Alsadi, I., Saleh, A., Abd Alati, M., & Abid, A. A. (2024). Microbiological evaluation of retail veal meat in the city of Al Bayda, Libya. AlQalam Journal of Medical and Applied Sciences, 335-340.
Montassier E, Batard E, Gastinne T. Neutropenia as an independent predictor of infection-related mortality in cancer patients: updated evidence. Support Care Cancer. 2023;31(6):2981–2989.
Shady I, Mohamed S, ElSayed M, Hassan R, El-Masry A. Gram-negative bacterial bloodstream infections in cancer patients: epidemiological trends and antibiotic susceptibility. J Infect Public Health. 2025;18(2):259–67.
Sitotaw B, Mekuria M, Mihret A. Bacterial profile and antimicrobial susceptibility patterns in cancer patients. Infect Drug Resist. 2021;14:1203–12.
Surendar, A. P., Palanivel, K. M., Saravanan, S., & Gopala-Krishnamurthy, R. (2017). Detection and characterization of infectious bronchitis virus in desi birds by molecular assay. Int J Curr Microbiol App Sci, 6, 1098-1102.
Wu L, Zhang Y, Zhang L, Li M, Gong Y, Liang Y, et al. Nosocomial infections due to multidrug-resistant bacteria in cancer patients: a six-year retrospective study of an oncology center in Western China. BMC Infect Dis. 2020;20:1–10.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 WSEAS Transactions on Biology and Biomedicine
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Author(s) and co-author(s) jointly and severally represent and warrant that the Article is original with the author(s) and does not infringe any copyright or violate any other right of any third parties and that the Article has not been published elsewhere. Author(s) agree to the terms that the WSEAS Journal will have the full right to remove the published article on any misconduct found in the published article.
