Spectrum of systemic bacterial infections during febrile neutropenia in pediatric oncology patients in tertiary care pediatric center

Siddaiahgari, Sirisharani; Manikyam, A; Kumar, Kalle Anand; Rauthan, Archana; Ayyar, Raji

doi:10.4103/0019-509x.175367

Cited by 20 publications

(29 citation statements)

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“…CONS comprised 85.7% of the Gram-positive isolates. Siddaiahgari et al (26) reported Gram-negative isolates in 85.3% of positive blood or urine cultures, with E. coli and Pseudomonas aeruginosa being the most common pathogens. Karanwal et al Half of the CONS were methicillin-resistant.…”

Section: Discussionmentioning

confidence: 99%

Bacteriological Spectrum and Antimicrobial Sensitivity of Pathogens in Children with Hematologic Malignancies and Febrile Neutropenia Research

et al. 2020

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Objectives: This study aimed to investigate the spectrum of bacterial pathogens and their antimicrobial sensitivity in pediatric patients admitted with febrile neutropenia (FN) and hematologic malignancies. Methods: This prospective, cross-sectional study was carried out on 65 children (60% boys, mean age 7.3 5.3 years) with hematologic malignancies and FN hospitalized at the Amir Hematology and Oncology Hospital, Shiraz, Iran, between December 2018 and May 2019. Samples were taken from blood, nose, axilla, and inguinal area (NAI). NAI cultures were repeated after 72 hours of admission, and blood culture was repeated if needed. A demographic questionnaire on age, sex, and admission time was filled out for each patient. Results: The most common grown bacteria in the NAI samples were coagulase-negative staphylococci (CoNS). Second cultures from these sites revealed nosocomial contamination. Eighteen patients (27.7%) had positive blood cultures, with 61.1 % of the isolated pathogens being Gram-negative (mostly Escherichia coli and Pseudomonas aeroginosa) and 38.9% Gram-positive. The blood cultures results did not match those of the NAI cultures in 61.1% of the patients. About one-fourth of the Gram-negative pathogens isolated from blood were resistant to cefepime, the main empirical antibiotic for FN management at our center. Conclusions: Gram-negative bacteria are predominant organisms in pediatric FN patients at our center, most resistant to cefepime. If a similar antimicrobial sensitivity pattern is observed in future studies, a change in local guidelines might be considered for FN management.

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Section: Discussionmentioning

confidence: 99%

Bacteriological Spectrum and Antimicrobial Sensitivity of Pathogens in Children with Hematologic Malignancies and Febrile Neutropenia Research

et al. 2020

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“…The changing microbiological spectrum, in febrile neutropenia and the resistance patterns, help guide antibiotic treatment. [7] Audit of febrile neutropenic episodes, would help guide treatment protocols to reduce the mortality and improve outcomes. We conducted a single centre prospective study aimed at identifying the trends in the pattern of microbiological isolates and sensitivity patterns for episodes of febrile neutropenia in the paediatric oncology unit of a tertiary care teaching hospital.…”

Section: Introductionmentioning

confidence: 99%

Re-thinking treatment strategies for febrile neutropenia in paediatric oncology population: A perspective from a developing country.

James¹,

Prakash

Mehta

et al. 2020

Preprint

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Background: This study was conducted to evaluate the microbiological profile of bacterial isolates in febrile neutropenia in a pediatric oncology unit, thereby, reviewing the use of restricted antibiotics and need for aggressive medical treatment accordingly.Methods: A prospective observational study was conducted in a paediatric haemat-oncology division of a tertiary care teaching hospital in southern India from September 2014 to August 2016. Children with febrile neutropenia were enrolled in the study. Blood cultures were performed using automated system. Cultures from other sites were obtained if needed, based on the clinical profile. Standard antibiotic susceptibility testing was done. Statistical analysis was done using SPSS.Results: One hundred and thirty children were enrolled for the study. Two hundred and fifty episodes of febrile neutropenia were studied. Three hundred and eighty four cultures were sent and 92 (24%) cultures were positive. There were 52.2% gram negative isolates followed 35.8% gram positive isolates, 6.5% fungal isolates and 5.5% poly-microbial cultures. Lactose fermenting gram negative bacteria (29 isolates, 31.5%) were the most frequently isolated in the gram negative group, with Escherichia coli being the most common organism (19 isolates, 20.6%). Amongst gram positive coagulase negative staphylococcus (CONS) was the most common (29%). Escherichia coli and NFGNB had only 36%, 25% sensitivity to ceftazidime respectively. Most gram negative bacteria were found to have better sensitivity to amikacin (mean: 57). There was a higher prevalence of extended spectrum beta lactamase producing organisms. 36 out of 48 GNB were found to be either multi/extremely/pan drug resistant. Escherichia coli and Klebsiella were often drug resistant. Significantly higher mortality was associated with gram negative isolates (61.5%)Conclusions: In view of higher prevalence of gram negative isolates and emergence of multi drug resistance, frequent audits of resistance patterns should guide the choice of antimicrobials in febrile neutropenia management. Our results show the importance of surveillance, monitoring resistance frequencies and identifying risk factors specific to each region. Given that significant mortality is attributed to drug resistant gram negative bacteria, early initiation of appropriate antibiotics to cover for drug resistance is required while formulating empirical antibiotic policies for febrile neutropenia in the oncology units in the developing world.

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“…The same has been echoed in the study by Mikulska et al [30], who found that a questionnaire based data obtained in 2011 reported predominance of Gram negative organisms compared to the published data between 2005-2011. It is also worth mentioning that the studies from developing countries such as India [12][13][14][21][22][23][24][25][26] have consistently demonstrated a predominance of Gram negative organisms, probably because of less use of central venous catheters. It is not only the predominant organism but their antibiotic sensitivity pattern that decide the choice of empirical antimicrobial therapy in children with FN.…”

Section: Introductionmentioning

confidence: 99%

“…Trimethoprim/sulfamethoxazole, amoxicillin/clavulanate and fluoroquinolones have been used as antibacterial prophylaxis in these children with success, but has been linked with the risk of emergence of antibiotic resistance [1]. Past several decades have witnessed substantial change in the bacterial etiology of pediatric febrile neutropenia ( Apart from the time period of study, the microbiology of febrile neutropenia is largely dependent on the regional differences based on socio-economic and healthcare developments [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Data from European Organization for Research and Treatment of Cancer (EORTC) during 1973-1994, reveals a decreasing incidence of Gram negative agents from 71% to 31% while Gram positive infection rose from 29% to 69% [28].…”

Section: Introductionmentioning

confidence: 99%

“…Till the 1990s the predominant etiological organism of pediatric FN world over were Gram positive bacteria but during the first decade of the 21st century Gram positive organisms became more prevalent specially in the developing countries with CONS (coagulase negative Staphyloccus aureus) being the most frequently isolated agent. Again during the present decade there seems to be a re-emergence of Gram negative organisms, particularly multidrug resistant (MDR) [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The same has been echoed in the study by Mikulska et al [30], who found that a questionnaire based data obtained in 2011 reported predominance of Gram negative organisms compared to the published data between 2005-2011.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Changing Microbiological Pattern of Pediatric Febrile Neutropenia

Mandal¹,

Singh²

2016

J Antimicrob Agents

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Spectrum of systemic bacterial infections during febrile neutropenia in pediatric oncology patients in tertiary care pediatric center

Abstract: Gram-negative organism is a common isolate in cancer children with febrile neutropenia, which is resistant to first-line antibiotic cefepime. Meropenem is most sensitive antibiotic and ESBL's are sensitive to piperacillin-tazobactam.

Cited by 20 publications

References 0 publications

Bacteriological Spectrum and Antimicrobial Sensitivity of Pathogens in Children with Hematologic Malignancies and Febrile Neutropenia Research

Bacteriological Spectrum and Antimicrobial Sensitivity of Pathogens in Children with Hematologic Malignancies and Febrile Neutropenia Research

Re-thinking treatment strategies for febrile neutropenia in paediatric oncology population: A perspective from a developing country.

Changing Microbiological Pattern of Pediatric Febrile Neutropenia

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