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

Abstract

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.

Gaps in diagnosing suspected infection in immunocompromised children with cancer: A systematic review

“…A summary of the study characteristics is shown in Figure 2. The included studies were from diverse regions globally, with six (18%) conducted in the United States 2,11–15 and 28 (82%) studies in other countries (Africa, n = 1 [3%]; Asia, n = 15 [44%]; Oceania, n = 2 [6%]; Europe, n = 4 [12%]; Middle East, n = 4 [12%]; Central America, n = 1 [3%]; South America, n = 1 [3%]) 16–43 (Figure S2). Majority ( n = 21, 62%) 2,11,12,16,18,19,21,25,26,28–35,38,39,42,43 of studies utilized standard culture methods, while a smaller number ( n = 8, 24%) 13,14,20,22–24,27,41 of studies reported on newer methods such as metagenomic sequencing and PCR diagnostics (i.e., qPCR [including singleplex and multiplex], 22,23 panfungal real‐time PCR, 27 16S rRNA gene PCR, 23,24 respiratory viral panel PCR, 13,20,41 and Pneumocystis jirovecii PCR 20 ).…”

“…The included studies were from diverse regions globally, with six (18%) conducted in the United States 2,11–15 and 28 (82%) studies in other countries (Africa, n = 1 [3%]; Asia, n = 15 [44%]; Oceania, n = 2 [6%]; Europe, n = 4 [12%]; Middle East, n = 4 [12%]; Central America, n = 1 [3%]; South America, n = 1 [3%]) 16–43 (Figure S2). Majority ( n = 21, 62%) 2,11,12,16,18,19,21,25,26,28–35,38,39,42,43 of studies utilized standard culture methods, while a smaller number ( n = 8, 24%) 13,14,20,22–24,27,41 of studies reported on newer methods such as metagenomic sequencing and PCR diagnostics (i.e., qPCR [including singleplex and multiplex], 22,23 panfungal real‐time PCR, 27 16S rRNA gene PCR, 23,24 respiratory viral panel PCR, 13,20,41 and Pneumocystis jirovecii PCR 20 ). Other assessed tests or studies included histopathology examination, 15 Aspergillus galactomannan antigen assay (GM), 15,17,20,27 (1‐3)‐β‐D‐glucan assay (BDG), 15,27 and procalcitonin and C‐reactive protein biomarkers 37 .…”

“…Patient sample sizes for the studies included in the systematic literature review are indicated in panel (A). All studies were observational with types reported in panel (B) (cross-sectional, N = 4 26,38,40,42 ; retrospective cohort, N = 17 2,[11][12][13][15][16][17][20][21][22]30,31,33,[35][36][37]39 ; prospective cohort, N = 13 14,18,19,[23][24][25][27][28][29]32,34,41,43 ). studies in the adult population.…”