G280(P) Microbiology of paediatric febrile neutropaenia in Uganda

Abstract

BackgroundOur paediatric oncology unit serves a population of over 37 million. Reducing mortality secondary to neutropaenic sepsis is a central focus of quality-improvement efforts. Lack of routine microbiology investigations represents a major obstacle to rational choice of empiric therapy for febrile neutropaenia (FN) and appropriate individualised management when first line treatment fails.AimsTo investigate causes of blood-stream infections and local antibiotic sensitivity patterns in paediatric oncology patients treated for FN.MethodsWe piloted routine use of blood cultures in children treated for FN over a 1-month period in May 2015. Peripheral blood cultures were taken from all potentially neutropaenic patients with fever ≥38°C prior to antibiotic treatment per local FN protocol. Sensitivity testing was performed manually and using BD Phoenix™ Automated Microbiology System.ResultsThere were 26 febrile episodes affecting 21 patients. Of 23 cultures performed, 5 (22%) demonstrated growth, all within 48 h. Three patients grew Staphylococcus areus; two grew Gram-negative organisms with sensitivity patterns consistent with extended-spectrum beta-lactamase (ESBL) expression. All three patients with S. aureus bacteraemia had clinically diagnosed soft tissue infection at a peripheral venous cannula site. All S. aureus isolates were methicillin-sensitive, but showed beta-lactamase activity and macrolide resistance. Both Gram-negative infections occurred in newly diagnosed leukaemia patients, one of whom was cultured immediately after transfer from another hospital. Both Gram-negative infections resulted in late septic deaths despite initial treatment with piperacillin-tazobactam/gentamicin followed by carbapenem/amikacin based on 48hr sensitivity results. Carbapenamase testing was unavailable.ConclusionsThis audit demonstrated a high yield of virulent pathogens associated with an unacceptable level of infection-related morbidity and mortality. None of the organisms cultured were sensitive to antibiotics mentioned in the SIOP PODC FN guideline. There is a clear need to review cannula care practices. Emergence and uncontrolled spread of resistant organisms poses a serious threat to our ongoing ability to deliver curative chemotherapy. There is an urgent need to address infection control on a local and healthcare system level, and to acknowledge that microbiology services are an essential component of any viable oncology service and must be prioritised in resource-limited settings.