Antibiotic-Resistant Septicemia in Pediatric Oncology Patients Associated with Post-Therapeutic Neutropenic Fever

Abstract

Death in cancer patients can be caused by the progression of tumors, their malignity, or other associated conditions such as sepsis, which is a multiphasic host response to a pathogen that can be significantly amplified by endogenous factors. Its incidence is continuously rising, which reflects the increasing number of sick patients at a higher risk of infection, especially those that are elderly, pediatric, or immunosuppressed. Sepsis appears to be directly associated with oncological treatment and fatal septic shock. Patients with a cancer diagnosis face a much higher risk of infections after being immunosuppressed by chemotherapy, radiotherapy, or anti-inflammatory therapy, especially caused by non-pathogenic, Gram-negative, and multidrug-resistant pathogens. There is a notorious difference between the incidence and mortality rates related to sepsis in pediatric oncologic patients between developed and developing countries: they are much higher in developing countries, where investment for diagnosis and treatment resources, infrastructure, medical specialists, cancer-related control programs, and post-therapeutic care is insufficient. This situation not only limits but also reduces the life expectancy of treated pediatric oncologic patients, and demands higher costs from the healthcare systems. Therefore, efforts must aim to limit the progression of sepsis conditions, applying the most recommended therapeutic regimens as soon as the initial risk factors are clinically evident—or even before they are, as when taking advantage of machine learning prediction systems to analyze data.

Frequency and Culture Sensitivity for Bacteremia During Febrile Neutropenia in Children with Acute Lymphoblastic Leukemia. Do Age and Gender Matter?

“…More recently, there has been re-emergence of gram-negative bacteria, in pediatric oncology patients. 5 Inonestudy, in a pediatric oncology unit, 74 (58%) cultures yielded Gram-negative bacilli, 51 (40%) were positive for Gram-positive cocci, and 3 (2%) grew fungi. 3 Another study found 69% positive blood cultures caused by gram-negative bacteria, 28.8% by gram-positive organisms, and 2.2% by fungi.…”

Mechanisms of Resistance to Quinolones

“…For example, Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae (other than Salmonella and Shigella), Pseudomonas aeruginosa, and Acinetobacter spp. [3,4].…”

“…To classify these microorganisms according to the degree of resistance and acquired resistance profiles, a group of experts in the field of antimicrobial resistance in joint work with the European Center for the Prevention of Diseases and Control (ECDC) and the CDC established the definitions and characteristics among resistant bacteria: multidrug-resistant (MDR), extensively drug-resistant (XDR), and pan drug-resistant (PDR) bacteria [3,4].…”

“…To establish objective parameters of the phenotypic resistance profile in each of these bacteria, epidemiologically significant antimicrobial categories were established. These categories were established based on the documents and cutoff points of the Clinical Laboratory Standards Institute (CLSI), the European Antimicrobial Sensitivity Testing Committee (EUCAST), and the US Food and Drug Administration (FDA) [3,4].…”

“…Based on the new limits and definitions: MDR bacteria possess acquired resistance to at least one antibiotic of three or more categories; XDR bacteria possess resistance to at least one antibiotic of almost all categories, except one or two of them; and PDR bacteria are resistant to all agents of all categories of antimicrobials [3,4].…”