Gram-negative Bacteremia in Children With Hematologic Malignancies and Following Hematopoietic Stem Cell Transplantation: Epidemiology, Resistance, and Outcome

Abstract

Gram-negative rod (GNR) infections adversely affect the outcome of patients with malignancies and following hematopoietic stem cell transplantation (HSCT). This retrospective observational study aimed to describe the epidemiology, outcome, and resistance patterns of GNR bacteremia in children with hematologic malignancies (HM) and after HSCT during the period spanning from 2010 to 2014 in a tertiary children’s hospital. A total of 270 children were included in the analysis; 65 (24%) developed 85 episodes of GNR bacteremia; the rate was 36/122 (29.5%) in post-HSCT and 29/178 (16.3%) in HM patients (P<0.05). Overall, 10% of the GNRs were carbapenem resistant. In multivariate analysis, prolonged neutropenia (≥7 d; odds ratio: 19.5, 95% confidence interval: 2.6-148.4) and total hospitalization for a duration of >30 days in the last 3 months (odds ratio: 17.5, 95% confidence interval: 1.4-224.4) were associated with carbapenem-resistant GNR bacteremia. Thirty-day mortality following GNR bacteremia was 0% in HM and 7/52 episodes (13.5%) in HSCT patients (P<0.05). Carbapenem-resistant versus carbapenem-sensitive bacteremia was associated with longer duration of bacteremia (mean: 3.8 vs. 1.7 d), higher risk for intensive care unit hospitalization (44.4% vs. 10.1%), and higher mortality rate (33% vs. 5.8%) (P<0.05). To summarize, GNR bacteremia was frequent, especially in post-HSCT children. Carbapenem resistance adversely affects patients’ outcome, increasing morbidity and mortality. Empirical antibiotic therapy must be adjusted to the local resistance patterns.

A Multicenter Clinical Study To Demonstrate the Diagnostic Accuracy of the GenMark Dx ePlex Blood Culture Identification Gram-Negative Panel

“…With this system, hands-on time from PBC bottles is < 2 minutes (19). The panel was challenged with a well-populated sample set representing the most identified gram-negative bloodstream pathogens (20)(21)(22)(23)(24)(25) and ARG targets, with an overall accuracy of 92.9% after discordant resolution. Although molecular discordant resolution has limitations, it is a practical option for a comparative accuracy study for molecular multiplex methods as conventional culture methods cannot detect nucleic acid and therefore Downloaded from https://journals.asm.org/journal/jcm on 13 July 2021 by 44.224.250.200. cannot verify the presence or absence of genetic sequences.…”

<p>Epidemiology of Febrile Neutropenia Episodes with Gram-Negative Bacteria Infection in Patients Who Have Undergone Chemotherapy for Hematologic Malignancies: A Retrospective Study of 10 Years’ Data from a Single Center</p>

“…A previous study in pediatric patients with hematologic malignancies showed that prolonged neutropenia and duration of hospitalization were associated with Gram-negative infection, especially carbapenem-resistant bacteremia. 15 In our study, 81% of FN patients were diagnosed with acute leukemia and 98 (39.7%) underwent stem-cell transplantation. The reason for these data may be that patients who underwent stemcell transplantation or induction and consolidation for acute leukemia were prescribed higher-dose chemotherapy, which may cause longer neutropenia.…”

Immune System Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

“…10 In a 2019 study of 126 children with malignant bone tumors, the only infectionrelated mortality occurred in children with severe neutropenia. 7 Although not all infections and deaths in these studies occurred in a critical care environment, the strong association between severe neutropenia and these adverse outcomes warrants inclusion of severe neutropenia in these criteria.…”

“…Data from the oncology literature has long indicated that an absolute neutrophil count ([% neutrophils 1 % band forms] × total white blood cell count) <500 cells per mm 3 confers significantly increased risk for the development of new infection and death. [7][8][9][10][11] A 10-year single-center survey of patients receiving cytolytic chemotherapy revealed that persistent neutropenia was strongly associated with mortality. 9 In a recent study of 270 children after hematopoietic stem cell transplant, prolonged severe neutropenia (>7 days) was strongly associated with an increased risk for Gram-negative bacteremia (odds ratio 19.5, 95% confidence interval 2.6-148).…”

“…9 In a recent study of 270 children after hematopoietic stem cell transplant, prolonged severe neutropenia (>7 days) was strongly associated with an increased risk for Gram-negative bacteremia (odds ratio 19.5, 95% confidence interval 2.6-148). 7 Similarly, among 120 children undergoing allogeneic hematopoietic stem cell transplant, the duration of severe neutropenia was a primary risk factor for invasive fungal infection. 10 In a 2019 study of 126 children with malignant bone tumors, the only infectionrelated mortality occurred in children with severe neutropenia.…”