Bacteremia in Pediatric Oncology Patients; A Single-Center Experience

Abstract

Objective: To study organisms causing bacteremia and their outcome in cancer children with febrile neutropenia (FN) admitted at our centre. Study Design: Retrospective longitudinal study. Place and duration of study: Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, from Feb to Dec 2017. Methodology: All pediatric oncology patients with febrile neutropenia admitted to the inpatient department were included. Data fields included age, diagnoses, demographics, organism types, time to positivity, multi-drug resistance, antibiotics, and outcome. Results: A total of 391 episodes of febrile neutropenia were documented among 86 patients. The mean age was 4.7±2.7 years. Twelve (14.0%) patients had intensive care admission, and 9(10.5%) of them died. Fifty-four (63.0%) children had primary diagnoses of haematological malignancies. Sixty-five percent had mucositis, central catheter, or both as risk factors. Thirty-nine isolates were cultured in 391 febrile-neutropenic episodes. Escherichia coli was the most frequently isolated organism in 16(41.0%) cultures, followed by Pseudomonas and Streptococcus pneumoniae in 4(10.3%) each. Poly-microbial isolates were seen in 6(15.4%) cultures. Multi-drug resistance was found in 12(30.8%) isolates. Thirty-four (87.0%) patients with positive cultures received appropriate antibiotics. Majority organisms were sensitive to Piperacillin/Tazobactam (14,35.9%) followed by Meropenem (10, 25.6%) and Colistin (6, 15.4%). Conclusions: Rapid identification of organisms from positive blood cultures combined with antimicrobial stewardship can have improved antibiotic treatment and outcomes.

Keywords

• Antimicrobial Stewardship
• Bacteremia
• Escherichia coli
• Febrile neutropenia
• Mucositis