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Bacteremia in Children with Solid Tumors: Etiology, Antimicrobial Susceptibility, Factors Associated with Multidrug
Amit Ginzburg1, Gal Goldstein2, Dror Raviv2
1Pediatric Infectious Diseases Unit, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel.
Insights
Multidrug-resistant (MDR) bacteremia is a significant concern in children with solid tumors. Gram-positive cocci showed higher MDR rates, highlighting the need for targeted empirical antibiotic strategies in pediatric oncology.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Clinical Microbiology
Background:
- Bacteremia poses a serious threat to immunocompromised children undergoing cancer treatment.
- Understanding the specific pathogens and their resistance patterns is crucial for effective management.
Purpose of the Study:
- To describe the causes and antibiotic resistance of bacteremia in pediatric solid tumor patients.
- To identify factors associated with multidrug-resistant (MDR) bacteremia and mortality in this population.
Main Methods:
- Retrospective analysis of bacteremia cases in children with solid tumors from 2011-2019.
- Identification and antimicrobial susceptibility testing of isolated pathogens.
- Logistic regression and univariate analyses to determine risk factors for MDR bacteremia and mortality.
Main Results:
- Gram-negative rods (GNR) constituted 61.0% and gram-positive cocci (GPC) 38.2% of 228 isolates.
- Key pathogens included Klebsiella pneumoniae, Escherichia coli, and coagulase-negative staphylococci.
- MDR rates were 18.2% for GNR and 55.2% for GPC.
- Factors associated with MDR-GNR included breakthrough bacteremia and neuroblastoma diagnosis; MDR-GPC was linked to hospitalization duration and treatment intensity.
- Shock, neutropenia, and PICU admission correlated with mortality.
Conclusions:
- Multidrug-resistant gram-positive cocci bacteremia is highly prevalent in pediatric solid tumor patients.
- Empirical antibiotic selection should consider patient-specific factors and local resistance patterns.
- Further research into novel therapeutic strategies is warranted to combat MDR infections in this vulnerable group.
Abstract:
This retrospective study aims to describe the etiology and resistance patterns of pathogens causing bacteremia in children with solid tumors in a tertiary pediatric hematology-oncology center in Jerusalem, Israel (2011-2019). Factors associated with multidrug-resistant (MDR) bacteremia and mortality were analyzed. A total of 228 pathogens were isolated in 126 patients; 61.0% were gram-negative rods (GNR) and 38.2% were gram-positive cocci (GPC). The most common pathogens were Klebsiella pneumoniae (19.3%), Escherichia coli (17.5%), and coagulase-negative staphylococci (16.2%). The proportion of MDR-GNR was 18.2%, while the proportion of MDR-GPC was 55.2%. In logistic regression analysis, breakthrough bacteremia on a penicillin-group antibiotic (odds ratio [OR] 5.69, [95% confidence interval 1.42-22.76], p-value = 0.014) was associated and underlying diagnosis of neuroblastoma was inversely associated (OR 0.17, [0.04-0.81], p-value = 0.026) with MDR-GNR bacteremia; while the previous hospitalizations' duration (OR 1.032/day, [1.01-1.06], p-value = 0.007) and oncologic treatment intensity (OR 2.19, [1.08-4.45, p-value = 0.03) were associated with MDR-GPC bacteremia. Shock, prolonged profound neutropenia, and pediatric intensive care unit (PICU) admission were associated with 7-day mortality; and relapsed disease, oncologic treatment intensity, prolonged profound neutropenia, and PICU admission-with 30-day mortality in the univariate analyses. Empirical antibiotic choice should be based on factors associated with MDR infections in this specific population.
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