Infection and Drug Resistance (Jul 2022)
Alarming Antibiotic Resistance in Pediatric Oncology Patients: A Three-Year Prospective Cohort Study from Oman
Abstract
Abeer Al Battashi,1 Bishara Al Harrassi,2 Nawal Al Maskari,3 Hilal Al Hashami,3 Salah Al Awaidy4 1Department of Pediatric Hematology and Oncology, The National Oncology Centre, Royal Hospital, Ministry of Health, Muscat, Oman; 2Oman Medical Specialty Board, Muscat, Oman; 3Pediatric Infectious Diseases, Child Health Department, Royal Hospital, Ministry of Health, Muscat, Oman; 4Office of Health Affairs, Ministry of Health, Muscat, OmanCorrespondence: Salah Al Awaidy, Office of Health Affairs, Ministry of Health, Al Khuwair Street, Muscat, Oman, Tel +968 99315063, Fax +968 24946381, Email [email protected]: Bloodstream infections (BSI) are severe and challenging oncological complications, with a consequent high morbidity and mortality in the immunocompromised. We reviewed the profile and susceptibility of bacteria associated with infections in children under 13 years of age receiving chemotherapy.Methods: Prospective cohort study of pediatric oncology patients was conducted between January 2015 and October 2017 at the Royal Hospital in Oman. Patient demographics, clinical data, laboratory parameters, microbial etiology and susceptibility, and outcomes were retrieved and analyzed.Results: A total of 74 episodes of positive bacterial blood cultures were detected in 38 oncology patients (positive blood culture rate of 51%). Fifty-seven percent were positive for gram-negative organisms with Klebsiella (21%) being the most common gram-negative organism cultured, and the most common gram-positive organism was Staphylococcus (coagulase negative Staphylococcus (CONs) and S. Aureus) (30%). The majority of patients had gastrointestinal complaints (74%), and almost half (51%) had prolonged periods of neutropenia (> 7 days). One third of gram-negative organisms were resistant to four or more antibiotics with a major resistance of 31% to piperacillin-tazobactam. Of the gram-positive organisms, 38% were resistant to at least four antibiotics and 30% were pan-resistant (except for vancomycin).Conclusion: The gram-negative organisms were dominant in BSIs with Klebsiella being the most common culprit. Bacteremia was prevalent, however, high resistance to first-line antibiotics was documented amongst gram-negative isolates, demanding strategies to ensure our patients’ safety.Keywords: neutropenia, pediatric oncology, bloodstream infections, antibiotic susceptibility, Oman
