Antibiotic-resistant Gram-negative Blood Stream Infections in Children With Cancer

Levene, Ilana; Castagnola, Elio; Haeusler, Gabrielle M

doi:10.1097/inf.0000000000001938

Cited by 19 publications

(11 citation statements)

References 29 publications

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“…These results are in line with the higher mortality of sepsis caused by Gram-negative bacteria and with the higher difficulty in treatment of infections in which are involved resistant strains. 27,28 In this study, focused on patients considered at higher risk of severe infection complications and infectious death, the 90-day mortality by sepsis-related organ failure and septic shock was 8.6% that is inferior to percentages reported in other studies. In a recent retrospective study, the mortality rate due to severe sepsis in pediatric oncohematological patients resulted 23%, 29 and previous studies reported mortality rates between 16 and 48%.…”

Section: Discussioncontrasting

confidence: 63%

Outcome and Risk Factors of Febrile Episodes Treated with Broad Spectrum Antibiotics and Polyclonal IgM–Enriched Immunoglobulin in Pediatric Oncology Hematology Patients: A Retrospective Study

Abram

Baretta

Mercolini

et al. 2021

J Pediatr Infect Dis

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Objective Preparations with high-titer immunoglobulin-M (HT-IgM) have been used to treat neonatal and adult sepsis as adjuvant to antibiotics. Limited data are available of this use in pediatric oncohematological patients. We retrospectively assessed the characteristics and outcome of febrile episodes treated with broad-spectrum antibiotics and HT-IgM. Methods The study included febrile episodes diagnosed after chemotherapy or hematopoietic stem cell transplantation (HSCT) treated with antibiotics and HT-IgM. Study period was from January 2011 to March 2019. Results Seventy febrile episodes in 63 patients were eligible. In 40% of episodes (n = 28), blood cultures identified a causative organism: Gram-negative (n = 15), Gram-positive (n = 8), polybacterial (n = 4), fungi (n = 1). Twenty-six percent of Gram-negatives were extend spectrum β-lactamase (ESBL)-producers. In 44% of episodes, a deep-organ localization was present, mostly pulmonary. Severe or profound neutropenia, hypotension, and hypoxemia were present in 89, 26, and 21% of episodes, respectively; 20% of episodes required intensive care and 20% of episodes required the use of inotropes. Overall, 90-day mortality was 13% and infection-attributable mortality resulted 8.6%. More than half of the patients received HT-IgM within 24 hours from fever onset. HT-IgM-related allergic reactions occurred in three episodes. Risk factors for 90-day mortality were as follows: hypotension and hypoxemia at fever presentation, admission to intensive care unit (ICU), use of inotropes, presence of deep-organ infection, and escalation of antibiotic therapy within 5 days. Conclusion The combination of broad-spectrum antibiotics and HT-IgM was feasible, tolerated, and promising, being associated with a limited infectious mortality. Further prospective controlled studies are needed to assess the efficacy of this combination over a standard antibiotic approach.

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Section: Discussioncontrasting

confidence: 63%

Outcome and Risk Factors of Febrile Episodes Treated with Broad Spectrum Antibiotics and Polyclonal IgM–Enriched Immunoglobulin in Pediatric Oncology Hematology Patients: A Retrospective Study

Abram

Baretta

Mercolini

et al. 2021

J Pediatr Infect Dis

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“…In studies of children with cancer, independent risk factors for AMR include prior antibiotic exposure and hospitalisation and AMR infections are associated with adverse outcomes including ICU admission, prolonged hospitalisation and death. 45,46 For patients travelling from overseas for treatment, the incidence of AMR at the sending centre may be unknown and the potential for AMR may be a particular consideration. To combat these concerns, diagnostic and AMS principles should be embedded within FN guidelines to ensure the right investigations are done and interpretation of these inform the right antibiotic choice and duration.…”

Section: Optimising Antimicrobial Selection Empiric Antibioticsmentioning

confidence: 99%

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Morgan¹,

Phillips²,

Haeusler³

et al. 2021

IDR

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Febrile neutropenia (FN) is a frequent complication of cancer treatment in children. Owing to the potential for overwhelming bacterial sepsis, the recognition and management of FN requires rapid implementation of evidenced-based management protocols. Treatment paradigms have progressed from hospitalisation with broad spectrum antibiotics for all patients, through to risk adapted approaches to management. Such risk adapted approaches aim to provide safe care through incorporating antimicrobial stewardship (AMS) principles such as implementation of comprehensive clinical pathways incorporating deescalation strategies with the imperative to reduce hospital stay and antibiotic exposure where possible in order to improve patient experience, reduce costs and diminish the risk of nosocomial infection. This review summarises the principles of risk stratification in FN, the current key considerations for optimising empiric antimicrobial selection including knowledge of antimicrobial resistance patterns and emerging technologies for rapid diagnosis of specific infections and summarises existing evidence on time to treatment, investigations required and duration of treatment. To aid treating physicians we suggest the key features based on current evidence that should be part of any FN management guideline and highlight areas for future research. The focus is on treatment of bacterial infections although fungal and viral infections are also important in this patient group.

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“…Infections are a common and dangerous complication in children with cancer [4,62]. In addition to bloodstream infections (generally caused by gram-negative bacteria [63]), CVCrelated infectious complications are also a relevant cause of morbidity.…”

Section: Microbiota and The Patient's Outcome: Infections Adverse Effects And Response To Treatmentmentioning

confidence: 99%

“…While early administration of broad-spectrum antibiotics has been shown to reduce mortality, there is some evidence that prophylactic antibiotic regimens may alter the human microbiota, thus inducing antibacterial resistance and the proliferation of MDR bacteria [62]. Two similar nonrandomized studies [66,67] evaluated blood cultures from pediatric cancer patients presenting with febrile neutropenia; in both studies, some patients underwent antibiotic prophylaxis with ciprofloxacin (a small portion of the patients in one study were not treated, but interestingly, all adult patients from the same center received FQL prophylaxis).…”

Section: Microbiota and The Patient's Outcome: Infections Adverse Effects And Response To Treatmentmentioning

confidence: 99%

Antimicrobial Prophylaxis and Modifications of the Gut Microbiota in Children with Cancer

et al. 2021

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In children with cancer, chemotherapy can produce cytotoxic effects, resulting in immunosuppression and an augmented risk of febrile neutropenia and bloodstream infections. This has led to widespread use of antibiotic prophylaxis which, combined with intensive chemotherapy treatment, could have a long-term effect on the gastrointestinal microbiome. In this review, we aimed to analyze the current literature about the widespread use of antibiotic prophylaxis in children experiencing infectious complications induced by chemotherapy and its effects on the gut microbiome. Our review of the literature shows that antimicrobial prophylaxis in children with cancer is still a trending topic and, at the moment, there are not enough data to define universal guidelines. Children with cancer experience long and painful medical treatments and side effects, which are associated with great economic and social burdens, important psychological consequences, and dysbiosis induced by antibiotics and also by chemotherapy. Considering the importance of a healthy gut microbiota, studies are needed to understand the impact of dysbiosis in response to therapy in these children and to define how to modulate the microbiome to favor a positive therapeutic outcome.

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Antibiotic-resistant Gram-negative Blood Stream Infections in Children With Cancer

Cited by 19 publications

References 29 publications

Outcome and Risk Factors of Febrile Episodes Treated with Broad Spectrum Antibiotics and Polyclonal IgM–Enriched Immunoglobulin in Pediatric Oncology Hematology Patients: A Retrospective Study

Outcome and Risk Factors of Febrile Episodes Treated with Broad Spectrum Antibiotics and Polyclonal IgM–Enriched Immunoglobulin in Pediatric Oncology Hematology Patients: A Retrospective Study

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children

Antimicrobial Prophylaxis and Modifications of the Gut Microbiota in Children with Cancer

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