Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study

Abstract

Purpose : This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. Methods : A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. Results : A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9 %). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P <0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6 % vs. 22.0%, P =0.04). Conclusion : This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia. (Korean J Pediatr Infect Dis 2012;19:131-140)

Increase in Antibiotic-Resistant Gram-Negative Bacterial Infections in Febrile Neutropenic Children

“…Among the GNB infections, the proportion of AR bacterial infections also tended to increase recently [ 2 7 8 10 19 20 21 ]. In Korean children with hematological/oncological disorders, GNB caused 49−62% of bacteremia cases in the 2000s, a higher proportion than in western children [ 22 23 24 ]. In the present study, 53.9% of bacteremia cases were caused by GNB, which was similar to the previous results in Korean children; however, it was higher than previously reported proportion of GNB, 41.8%, in our hospital in 2009.…”

“…Previous studies on Korean children with hematological/oncological disorders reported that 15−21% of bacteremia due to E. coli and Klebsiella spp. was caused by ESBL-producing strains and 71% of bacteremia due to A. baumannii was caused by CRAB [ 22 23 24 ]. In addition, 42−75% of bacteremia cases due to Enterococci were caused by VRE, 29−50% of bacteremia cases due to S. aureus were caused by MRSA, and 82−87% of bacteremia cases due to CNS were caused by MRCNS [ 22 23 24 ].…”

“…was caused by ESBL-producing strains and 71% of bacteremia due to A. baumannii was caused by CRAB [ 22 23 24 ]. In addition, 42−75% of bacteremia cases due to Enterococci were caused by VRE, 29−50% of bacteremia cases due to S. aureus were caused by MRSA, and 82−87% of bacteremia cases due to CNS were caused by MRCNS [ 22 23 24 ]. In the present study, MRCNS comprised 88.5% of this proportion, which was similar to previously reported proportions in Korean children (82−87%) and adults admitted to hematology wards in our hospital (92.9%) [ 25 ].…”

Clinical Significance of Isolates Known to Be Blood Culture Contaminants in Pediatric Patients

“…However, children with potential immunocompromised status are known to have blood stream infection from coagulase negative Staphylococcus [2,3,4]. Korean studies have shown that among Gram-positive organisms, coagulase negative Staphylococcus and viridans group Streptococcus are most frequently isolated from immunocompromised pediatric blood cultures [5,6]. These findings are of interest.…”