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Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer
Julia R Spinardi1, Rodrigo Berea1, Patricia A Orioli1
1MD, Department of Pathology (Division of Microbiology), Santa Casa de São Paulo School of Medicine, Rua Dr Cesario Mota Junior 61, São Paulo, SP, Brazil.
Insights
Colonization screening in febrile neutropenia (FN) in children undergoing chemotherapy is crucial. Including anal swabs significantly increases detection of Staphylococcus aureus and Enterococcus spp., aiding targeted antibiotic therapy and reducing infection risks.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Microbiology
Background:
- Febrile neutropenia (FN) is a severe complication of cancer chemotherapy.
- Neutropenic patients are at high risk for infections and colonization by multidrug-resistant organisms.
- Prompt identification of pathogens is critical for effective treatment and improved outcomes.
Purpose of the Study:
- To investigate the colonization patterns of *Staphylococcus aureus* and *Enterococcus* spp. in hospitalized children with febrile neutropenia.
- To determine the antimicrobial resistance profiles of these colonizing bacteria.
- To evaluate the impact of including anal swabs in screening protocols.
Main Methods:
- Samples were collected using nasal, oropharyngeal, and anal swabs from children with febrile neutropenia.
- The study period was between March 2014 and 2015.
- Bacterial identification and antimicrobial susceptibility testing were performed.
Main Results:
- *Staphylococcus aureus* colonization was identified in 22% of patients, with methicillin-resistant *S. aureus* (MRSA) in 13.6%.
- Including anal swabs increased the detection rate of colonized patients by 20%.
- *Enterococcus* spp. were found in 27% of patients, with vancomycin-resistant enterococci (VRE) accounting for 25% of isolates, primarily found in oropharyngeal swabs.
Conclusions:
- Comprehensive colonization screening, including multiple body sites like anal swabs, enhances pathogen detection in febrile neutropenic children.
- Understanding colonization profiles is essential for optimizing empirical antibiotic treatment, improving antibiotic adequacy, and reducing the development of resistance.
- This approach can contribute to better clinical outcomes and decreased hospitalization duration.
Introduction:
Febrile neutropenia is one of the most serious treatment-related complications in cancer patients. Susceptible to rapidly progressing infections, which result in prolonged hospitalization and use of broad-spectrum antibiotics, neutropenic patients are subject to colonization by multiresistant agents, which enhances the risk of infections.
Methods:
In this study we included samples collected with nasal, oropharyngeal and anal swabs from hospitalized children with febrile neutropenia following chemotherapy, between March 2014 and 2015, aiming to elucidate colonization by S. aureus and Enterococcus spp., as well as their resistance profile.
Results:
S. aureus was found in 22% of the patients and 14% of the events. Methicillin-resistant S. aureus colonized 13.6% of patients. Including anal swabs in the screening increased the identification of colonized patients by 20%. Enterococcus spp. was found in 27% of patients and 17% of episodes. Enterococcal isolates resistant to vancomycin, accounting for 25% of the total, were not isolated in anal swabs at any time, with the oropharyngeal site being much more important. The rate of infection by Enterococcus spp. was 4.5% of all patients and 16% among the colonized patients.
Conclusion:
Especially in this population, colonization studies including more sites can yield a higher chance of positive results. Establishing the colonization profile in febrile neutropenic children following chemotherapy may help to institute an empirical antibiotic treatment aimed at antibiotic adequacy and lower induction of resistance, thereby decreasing the risk of an unfavorable clinical outcome.
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