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

Abstract

BackgroundThe incidence of bacteremia caused by Gram-negative bacteria has increased recently in febrile neutropenic patients with the increase of antibiotic-resistant Gram-negative bacterial infections. This study aimed to identify the distribution of causative bacteria and the proportion of antibiotic-resistant bacteria in bacteremia diagnosed in febrile neutropenic children.Materials and MethodsThe medical records of febrile neutropenic children diagnosed with bacteremia between 2010 and 2014 were retrospectively reviewed. The causative bacteria and proportion of antibiotic-resistant bacteria were investigated and compared yearly during the study period. The clinical impact of antibiotic-resistant bacterial infections was also determined.ResultsA total of 336 bacteremia episodes were identified. During the entire study period, 181 (53.9%) and 155 (46.1%) episodes were caused by Gram-negative and Gram-positive bacteria, respectively. Viridans streptococci (25.9%), Klebsiella spp. (16.7%), and Escherichia coli (16.4%) were the most frequent causative bacteria. The overall distribution of causative bacteria was not significantly different annually. Antibiotic-resistant bacteria were identified in 85 (25.3%) episodes, and the proportion of antibiotic-resistant bacteria was not significantly different annually. Extended-spectrum β-lactamase-producing E. coli and Klebsiella spp. were most common among antibiotic-resistant Gram-negative bacteria, and they accounted for 30.6% (n = 34) of the identified E. coli and K. pneumoniae. Methicillin-resistant coagulase-negative staphylococci were most common among antibiotic-resistant Gram-positive bacteria, and it accounted for 88.5% (n = 23) of the identified coagulase-negative staphylococci. Antibiotic-resistant bacterial infections, especially antibiotic-resistant Gram-negative bacterial infections, caused significantly higher mortality due to bacteremia compared with non-antibiotic-resistant bacterial infections (P <0.001).ConclusionRecently, Gram-negative bacteria caused more bacteremia cases than Gram-positive bacteria in febrile neutropenic children, and antibiotic-resistant Gram-negative bacterial infections increased. Antibiotic-resistant bacterial infections caused poorer prognosis compared with non-antibiotic-resistant bacterial infections, and therefore, continuous surveillance for changing epidemiology of antibiotic-resistant bacterial infections and their clinical impact is necessary.

Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients

“…In a study conducted in Turkey, it was reported that febrile neutropenia attacks developed most commonly during the consolidation treatment in patients with pediatric leukemia treated with the BFM protocol (29). In the study conducted by Lee et al (38), it was reported that febrile neutropenia most commonly developed after the consolidation period. In our study, febrile neutropenia attacks developed most commonly in the reinduction period.…”

Neutropenia febril en niños con cáncer: manejo en el servicio de emergencias

“…A pesar de que generalmente la fiebre en estos niños es secundaria a una condición infecciosa benigna (por ejemplo, una virosis), hasta 20% pueden tener una infección bacteriana grave [16][17][18] (Tabla 1). Uno de los aspectos más importantes para el manejo del paciente es la búsqueda de la "puerta de entrada" de agentes infecciosos al torrente sanguíneo.…”

“…Uno de los aspectos más importantes para el manejo del paciente es la búsqueda de la "puerta de entrada" de agentes infecciosos al torrente sanguíneo. Para ponerlo en perspectiva, esto es el doble de riesgo que tienen los neonatos febriles [16][17][18] . Debido a que la reacción inflamatoria del paciente con neutropenia febril es escasa o está ausente, no focaliza adecuadamente las infecciones 4 .…”

“…Interesantemente, a partir del año 2012 ha habido un aumento en los reportes de infección por bacilos gramnegativos, así como de los episodios de bacteriemia por microorganismos multi-resistentes 20,21 . Estas tendencias pueden deberse a muchos factores, entre los cuales se incluyen la introducción de nuevos tratamientos quimioterapéuticos, neutropenias de mayor intensidad y duración, presión de selección bacteriana por el uso de profilaxis antimicrobiana, mayor uso de catéteres venosos centrales, y prolongación de la estancia hospitalaria 4 .…”

Granulocyte transfusions: A concise review for practitioners

“…All the positive evidence thus lies on the older trials, which 1) Included mainly bacterial infections 2) Precede modern antibiotics like third-generation cephalosporins and carbapenems 3) Precede the era of growth factors that may shorten the duration of neutropenia and 3) Precede the use of new antifungals like voriconazole, posaconazole or echinocandins. Of particular interest, the control groups in the early positive controlled trials documented the mortality of gram-negative bacteremia to be 70–100%, which seem to be much worse than current practice: the mortality of gram-negative bacteremia in neutropenic patients currently reported varies between 5% for susceptible bacteria and 20% for resistant bacteria [36,37]. …”