Spectrum of lower respiratory tract infections and antimicrobial resistance pattern in head and neck cancer patients undergoing chemoradiation.

BACKGROUND: Head and neck cancer (HNCs) is a major health issue worldwide, and India has contributed to approximately 2.4 lakh new cases in 2022. Definitive chemoradiation is the standard treatment for locally advanced disease but carries a risk of lower respiratory tract infections (LRTI) that add to morbidity, hospitalization, cost, and possible delay in treatment. The increasing incidence of antimicrobial resistance (AMR) has also contributed to management burden. This study aimed to assess the microbiological profiles and antimicrobial resistance patterns of lower respiratory tract infections in patients with head and neck cancer receiving chemoradiation. METHODS: Patients who underwent definitive radiotherapy with or without chemotherapy and who developed LRTIs were included in the study. Sputum and tracheostomy suction tip cultures were obtained and processed using standard microbiological techniques such as Gram staining, biochemical tests, and VITEK-2 automated systems. Antimicrobial susceptibility was tested according to the Clinical and Laboratory Standards Institute (CLSI) and EUCAST recommendations. Clinical and treatment-related factors were documented and compared using SPSS version 23.0, with descriptive statistics, chi-square tests, t-tests, ANOVA, and logistic regression models. RESULTS: Pseudomonas aeruginosa was the most frequently isolated pathogen (35.0%), followed by Klebsiella pneumoniae (16.7%), and Acinetobacter baumannii (10.0%). The pathogens were strongly resistant to fluoroquinolones and third-generation cephalosporins but were susceptible to carbapenems and aminoglycosides in the majority of isolates. Pseudomonas aeruginosa was the most frequent pathogen in all age groups and chemotherapy regimens (p<0.001). CONCLUSION: LRTIs in patients with HNC treated with chemoradiation were mainly caused by multidrug-resistant Pseudomonas aeruginosa and Klebsiella pneumoniae. Resistance patterns are crucial for directing empirical antibiotic therapy, minimizing treatment delays, and enhancing clinical outcomes.