Bacterial bloodstream infections and antimicrobial susceptibility pattern in pediatric hematology/oncology patients after anticancer chemotherapy

Abstract

PurposeBloodstream infections in pediatric hematology and oncology represent a major problem worldwide, but this has not been studied in Qatar. In this study, we investigated the burden of infection and the resistance pattern in the bacterial etiology, in the only tertiary pediatric hematology and oncology center in Qatar.MethodsAll pediatric cancer patients (n=185) were evaluated retrospectively during the period 2004–2011; a total of 70 (38%) patients were diagnosed with bloodstream infections. Bacterial etiology was determined, along with their susceptibility patterns. Neutropenia, duration of neutropenia, fever, duration of fever, and C-reactive protein (CRP) were evaluated throughout the study.ResultsA total of 70 patients (38%) were diagnosed with acute leukemias, lymphomas, solid tumors, or brain tumors; those patients experienced 111 episodes of bacteremia. The most common Gram-positive (n=64 [55%]) isolates were Staphylococcus epidermidis (n=26), Staphylococcus hominis (n=9), and Staphylococcus haemolyticus (n=7), and the common Gram-negative (n=52 [45%]) isolates were Klebsiella pneumoniae (n=14), Pseudomonas aeruginosa (n=10), and Escherichia coli (n=7). There was a significant association observed between fever with positive blood culture and different types of cancer (P=0.035). The majority of bacteremia (n=68 [61.3%]) occurred in nonneutropenic episodes. Elevated values of CRP (≥5 mg/L) were detected in 82 (95.3%) episodes and were negatively correlated with absolute neutrophil count (ANC) (r=−0.18; P=0.248) among all cases. However, the infection-related fatality rate was 2.2% (n=4), with three caused by Gram-negative pathogens. Multidrug resistant organisms were implicated in 33 (28.4%) cases and caused three of the mortality cases.ConclusionMultidrug resistant organisms cause mortality in pediatric cancer patients. Investigation of antimicrobial susceptibility of these organisms may guide successful antimicrobial therapy and improve the surveillance and quality of pediatric malignancy care.

Prevalence of Infectious Complications in Children with Cancer

“…A similar data was presented in 2004 by S Mahmoud et al [25] from Pakistan with 44% positive cultures from 62 episodes with blood as the most common site 24% as compared to our 16%. A recent study from Qatar was published by N AlMulla et al [26] with the same pattern of organisms as our study with Staphylococcus as the most common gram positive and Klebsiella as the most common gram negative organism. H Ashour and A Alshareef [27] from Cairo reported the same organisms (G negative) in 2009.…”

Bloodstream infections in oncology patients at Red Cross War Memorial Children’s Hospital, Cape Town, from 2012 to 2014

“…Since the 1970s, an increasing proportion of Gram-positive bacteria has been noted as the cause of BSI in paediatric oncology (Al-Mulla et al, 2014;Litterman et al, 2013;Huang et al, 2007;Wehl et al, 1999;Van de Wetering et al, 2005). Similarly, Grampositive bacteria, particularly CoNS and VGS, were the predominant causes of BSI in the present study.…”

“…Neutropenia disables the immune system, increasing the risk of infection, and alters the spectrum of organisms that cause infection (Castagnola et al, 2005;Adler et al, 2006). Intensive chemotherapy increases this risk by causing neutropenia and defects in mucosal barriers such as mucositis (Al-Mulla et al, 2014;Johannsen et al, 2013). Defects in mucosal barriers of the gastrointestinal tract increase the risk of infection by bacteria that normally colonize the gastrointestinal tract (Johannsen et al, 2013;Nielsen et al, 2016).…”

“…Patients with haematological malignancies and cancers with bone marrow infiltration are at increased risk of infection. Bone marrow suppression with neutropenia and/or lymphopenia may occur as a result of chemotherapy and radiotherapy, rendering the innate and adaptive immune systems dysfunctional (Al-Mulla et al, 2014;Litterman et al, 2013;Matthay et al, 2001). Such patients easily develop opportunistic infections (Huang et al, 2007).…”

Bloodstream infections in pediatric hematology/oncology patients: Six years’ experience of a single center in Turkey

“…Gram-positive pathogens are an important problem in healthcare-associated infections. Identifying the causative agents may be sometimes difficult due to the isolated pathogen being a part of the normal skin flora [25]. Although different infection rates have been reported in many studies from our country, methicillin-resistant S. aureus is frequently isolated in many centers [21].…”