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Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer
Angeliki-Eleni Sfetsiori1, Dimitrios Doganis2, Anastasios Doudoulakakis3
1Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens.
Insights
Identifying predictive factors for Gram-negative vs. Gram-positive bacteremia in pediatric cancer patients is crucial for effective antibiotic treatment. Girls, hematologic malignancy, and higher CRP levels predict Gram-negative infections, while neutropenic boys with solid tumors and CVCs may face Gram-positive risks.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Bacterial bloodstream infections (BSIs) are a significant concern in pediatric cancer patients.
- Timely identification of bacteremia type (Gram-negative vs. Gram-positive) is critical for appropriate empiric antibiotic therapy.
- Predictive factors for bacteremia type can optimize treatment strategies.
Purpose of the Study:
- To identify demographic, clinical, and laboratory factors predicting the type of bacteremia in children with cancer.
- To correlate these factors with Gram-negative versus Gram-positive bacterial isolates.
- To inform empiric antibiotic selection for pediatric cancer patients with BSI.
Main Methods:
- Retrospective analysis of children with cancer and bacterial bloodstream infections (BSIs) from February 2011 to February 2018.
- Examination of demographic, clinical, and laboratory data.
- Correlation of patient characteristics with the type of isolated bacteria (Gram-negative vs. Gram-positive).
Main Results:
- Gram-negative bacteria were more frequent in girls, patients with prior BSIs, and those with hematologic malignancies.
- Gram-negative BSIs correlated with lower leukocyte, neutrophil, and platelet counts, and higher C-reactive protein (CRP) levels.
- Female sex, hematologic malignancy, and elevated CRP were independent risk factors for Gram-negative BSI; neutropenic boys with solid tumors and recent central venous catheter (CVC) placement were at increased risk for Gram-positive BSI.
Conclusions:
- Gram-negative and Gram-positive BSIs are nearly balanced in pediatric cancer patients.
- Girls, hematologic malignancies, and higher CRP levels are associated with Gram-negative bacteremia.
- Neutropenic boys with solid tumors and recent CVC placement may require initial antibiotics targeting Gram-positive bacteria.
Background:
Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment.
Materials And Methods:
Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria.
Results:
Among 224 monomicrobial bacterial BSI episodes, Gram-negative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.7:1) versus boys (Gram-negative/Gram-positive ratio 0.72:1), P=0.002, in patients with previous BSI episodes (1.4:1) versus those without (0.8:1), P=0.042, and in children with hematologic malignancy (1.3:1) versus those who suffered from solid tumors (0.52:1), P=0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P=0.009, neutrophils, P=0.009 and platelets, P=0.002, but with significantly higher C-reactive protein (CRP) levels, P=0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis.
Conclusions:
Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria.
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