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Alarming Upward Trend in Multidrug-Resistant Bacteria in a Large Cohort of Immunocompromised Children: A Four-Year

Ana-Raluca Mihalcea1,2, Nathalie Garnier1,2, Cécile Faure-Conter1,3

  • 1Institute of Pediatric Hematology and Oncology (IHOPe), 69008 Lyon, France.

Cancers
|February 11, 2023
PubMed

Insights

Multidrug-resistant bacteria (MDRB) are increasingly causing gut colonization and bloodstream infections (BSI) in immunocompromised children. Higher immunosuppression levels correlate with increased MDRB risk, necessitating careful antibiotic stewardship.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Resistance
  • Immunocompromised Hosts

Background:

  • Bacteremia in febrile immunosuppressed children often leads to broad-spectrum antibiotic use.
  • Central venous catheters are common in this population, increasing infection risk.
  • Understanding evolving antibiotic resistance is crucial for effective treatment.

Purpose of the Study:

  • To analyze the trends in antibiotic resistance profiles of bacterial bloodstream infections (BSI) and gut colonizations.
  • To compare current resistance patterns with a previous study (2014-2017) in immunocompromised children.
  • To assess the correlation between immunosuppression levels and multidrug-resistant bacteria (MDRB) acquisition.

Main Methods:

  • Retrospective, observational cohort study (January 2018 - December 2021).
  • Tertiary care center specializing in pediatric immuno-hematology and oncology.
  • Data collected on BSI, gut colonization, and patient immunosuppression levels.

Main Results:

  • Mean of 6.9 BSI per 1000 patient bed days.
  • Multidrug-resistant bacteria (MDRB) accounted for 12.8% of BSIs (35/273).
  • Annual increase in MDRB gut colonization and BSI, correlated with immunosuppression (p=0.024).
  • 34.7% of BSI episodes occurred without neutropenia.

Conclusions:

  • An alarming emergence of MDRB causing gut colonization and BSI in immunosuppressed children was observed.
  • The degree of immunosuppression directly correlates with the risk of MDRB gut colonization and BSI.
  • Findings highlight the need for updated antibiotic strategies in this vulnerable population.

Keywords:
bacterial bloodstream infectionsimmunosuppressionmultidrug resistanceneutropeniapaediatric haematology and oncology

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