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Updated: Mar 26, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Invasive bacterial infections in a pediatric oncology unit in a tertiary care center
A Trehan1, S Totadri, V Gautam
1Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background:
Multidrug resistant (MDR) pathogens are becoming a major problem worldwide, more so in the immunocompromised hosts resulting in the urgent need of antibiotic stewardship.
Purpose:
To analyze the organisms isolated and the drug resistance pattern in a pediatric oncology unit.
Results:
Data pertaining to infections with 128 positive cultures in patients with febrile neutropenia over a period of 1-year are presented. The unit antibiotic policy is decided depending on the sensitivity of the prevailing common organisms. We isolated Gram-negative organisms in 56% cases. Escherichia coli and Klebseilla were the most frequent lactose fermenting Gram-negative Bacilli and Pseudomonas and Acinetobacter the nonfermenting Gram-negative Bacilli. Only 20-30% of the Gram-negative organisms cultured were sensitive to a 3rd/4th generation cephalosporin. The combination of a beta-lactam/inhibitor covered 2/3rd of Gram-negative organisms. About 80% of the organisms were sensitive to carbapenems. There was no colistin resistance. About 44% of our cultures grew a Gram-positive bacterial organism and included coagulase negative Staphylococcus. We had an incidence of methicillin resistant Staphylococcus aureus to be 30%. About 30% of the enterococci isolated in our unit were vancomycin-resistant enterococci. About 23% of patients with a positive bacterial culture died.
Conclusions:
Infections in pediatric cancer patient's account for about 15-20% of the deaths in developing countries as these patients are at a high risk for developing MDR infections. Resistance rates among Gram-positive and Gram-negative organisms have increased worldwide. Every unit needs a rational antibiotic policy. Antibiotic de-escalation and judicious decrease in the duration of antibiotics needs to be practiced.
Insights
Multidrug-resistant infections are a significant threat in pediatric oncology. This study highlights high resistance rates and the need for rational antibiotic policies to combat these challenging pathogens.
Area of Science:
- Infectious Diseases
- Oncology
- Microbiology
Background:
- Multidrug-resistant (MDR) pathogens pose a growing global health threat, particularly impacting immunocompromised individuals.
- The increasing prevalence of MDR infections necessitates robust antibiotic stewardship programs.
Purpose of the Study:
- To investigate the spectrum of microbial organisms and their antimicrobial resistance patterns within a pediatric oncology unit.
- To inform the development of a targeted antibiotic policy for this high-risk patient population.
Main Methods:
- A retrospective analysis of 128 positive cultures from patients with febrile neutropenia over one year.
- Identification of bacterial isolates and susceptibility testing to various antibiotic classes.
Main Results:
- Gram-negative bacteria were prevalent (56%), with high resistance to third/fourth-generation cephalosporins but significant susceptibility to carbapenems (80%).
- Gram-positive organisms accounted for 44% of cultures, including Methicillin-resistant Staphylococcus aureus (30%) and Vancomycin-resistant Enterococci (30%).
- No colistin resistance was observed; however, 23% of patients with positive cultures died.
Conclusions:
- Pediatric cancer patients are highly susceptible to MDR infections, contributing to mortality.
- Elevated resistance rates in both Gram-positive and Gram-negative bacteria underscore the need for evidence-based antibiotic stewardship.
- Implementing rational antibiotic policies, including de-escalation and optimized duration, is crucial for managing infections in this vulnerable group.
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