Characteristics and Outcomes of Bloodstream Infections in a Tertiary-Care Pediatric Hematology–Oncology Unit: A 10-Year Study

Abstract

Bloodstream infections (BSIs) after chemotherapy or hematopoietic stem cell transplantation (HSCT) are a leading cause of morbidity and mortality. Data on 154 BSIs that occurred in 111 onco-hematological patients (57 hematological malignancies, 28 solid tumors, and 26 non-malignant hematological diseases) were retrospectively collected and analyzed. Monomicrobial Gram-positive (GP), Gram-negative (GN), and fungal BSIs accounted for 50% (77/154), 38.3% (59/144), and 3.2% (5/154) of all episodes. Polymicrobial infections were 7.8% (12/154), while mixed bacterial–fungal infections were 0.6% (1/154). The most frequent GN isolates were Escherichia coli (46.9%), followed by Pseudomonas aeruginosa (21.9%), Klebsiella species (18.8%), and Enterobacter species (6.3%). Overall, 18.8% (12/64) of GN organisms were multidrug-resistant (seven Escherichia coli, three Klebsiella pneumoniae, and two Enterobacter cloacae), whereas GP resistance to glycopeptides was observed in 1% (1/97). Initial empirical antibiotic therapy was deemed inappropriate in 12.3% of BSIs (19/154). The 30-day mortality was 7.1% (11/154), while the bacteremia-attributable mortality was 3.9% (6/154). In multivariate analysis, septic shock was significantly associated with 30-day mortality (p = 0.0001). Attentive analysis of epidemiology and continuous microbiological surveillance are essential for the appropriate treatment of bacterial infections in pediatric onco-hematological patients.

High morbidity and mortality associated with primary bloodstream infections among pediatric patients with cancer at a Guatemalan tertiary referral hospital

“…It is unclear whether including these organisms would have changed the observed morbidity and mortality. In particular exclusion of single isolates of coagulase negative staphylococci may have skewed the distribution of our isolates toward Gram negative bacilli relative to other studies ( 19 , 20 ). Nevertheless, as only 8% of episodes in our study occurred in patients with a permanent central venous line, these organisms were more likely to be contaminants than in cohorts where permanent venous line use was more prevalent.…”

Bloodstream Infections in Pediatric Oncology Patients: Bacterial Pathogen Distribution and Antimicrobial Susceptibility at the University Hospital Centre Zagreb, Croatia—A 5-Year Analysis

“…These findings may be linked to the following reasons: (a) large use of CVC in the pediatric population; although Gram-negative bacteria can also cause CVC-related BSI with their frequency ranging from 20% to 27%; CoNS are the most common pathogens involved in this type of infection; and (b) empirically used antimicrobial regimens 20 . As opposed to that, chemotherapy-induced mucositis that leads to bacterial translocation of gut organisms is most likely the reason for Gram-negative bacteria more commonly found as microorganisms causing BSIs in patients with neutropenia 2,14,20–25 …”

“…Bloodstream infections (BSIs) are a major cause of morbidity and mortality in children with cancer and the range of incidence varies from 6.1% to 50% with an overall mortality of >6%. Neutropenia is the most important predisposing factor 1,2 . Gram-positive bacteria were the main pathogens in patients with neutropenia during the 1980s and the beginning of the 1990s.…”

“…This was a result of the widespread use of fluoroquinolone antimicrobial prophylaxis but it was also brought on by the use of long-term intravascular catheters, high-dose chemotherapy-induced mucositis, and antacid and histamine blockers usage 3–5 . Currently, this trend has been reversing at some centers with Gram-negative organisms again becoming more prevalent 2,6 . Shift to the Gram-negative bacteria is interpreted to be a consequence of the improvement in the overall handling of central venous catheters (CVCs), the emergence of Gram-negative bacteria resistant to fluoroquinolones, and the diffusion of chemotherapy protocols associated with higher intestinal toxicity and endogenous bacteremia 6 …”

“…At the same time, there is a global spread of multidrug-resistant (MDR) bacteria and hematology/oncology wards are not spared. Enterobacterales with extended spectrum β-lactamases and carbapenemases, MDR Pseudomonas aeruginosa are of special importance and some centers are also reporting a high prevalence of vancomycin-resistant enterococci (VRE) 2,6,7 …”