Pediatric Hematology Oncology Journal (Mar 2023)
Factors associated with mortality from gram-negative bacterial infections in children with cancer
Abstract
Background/objectives: Gram negative bacteria (GNB) infection in children with cancer is an undesirable consequence of high intensity treatment. Our objective was to identify the prevalence of GNB infection in children with cancer, sensitivity patterns, mortality rates and factors associated with mortality. Design/methods: We retrospectively analysed clinical and microbiological data of all newly diagnosed paediatric (0–18 years) cancer patients in Max Super Speciality Hospital, Saket and Patparganj in New Delhi who had GNB growths in their blood cultures from March 2013 to April 2019. Bacterial sensitivity to various antimicrobial agents was determined. Outcome of interest was death from GNB infection. Results: A total of 1170 blood cultures were obtained from 485 children (range 0–28/child, median 1/child). Of these 213 (18.2%) were positive with 108 (50.7%) gram-positive bacteria, 87 (40.8%) with GNB and 18 (8.5%) with fungal. Sensitivity to piperacillin/tazobactam, amikacin, meropenem and colistin was observed in 38.4%, 57.6%, 51.5% and 95.3% of the GNB isolates, respectively. Sensitivity to our first line combination of piperacilin/tazobactam plus amikacin was observed in 72.7% of Pseudomonas species, 71.4% Acinetobacter species, 66.7% Enterobacter cloacae, 60% Klebsiella species and 42.1% of E coli. There were 9 deaths (mortality rate 18%). There was no significant difference in mortality by age group, gender, country, hospital, cancer type and type of GNB. Factors significantly associated with mortality were low neutrophil count and resistance to first line antibiotics. Conclusion: GNB Infection in children with cancer in India is characterized by high antibiotic resistance. Multidrug resistance and neutropenia are associated with increased risk of mortality.
