Prevalence and Outcomes of Carbapenem-resistant Bloodstream Infection in Children With Cancer

Carbapenem-resistant (CR) infections cause major morbidity and mortality. Data on CR infections in children with cancer are scarce, especially from the developing world. The aim of this study was to evaluate the characteristics and outcomes of bacteremia with CR organisms (CRO) compared with bacteremia with Carbapenem-sensitive organisms in children with cancer.

This retrospective observational study was conducted in a tertiary pediatric oncology center in South India. Data on all bloodstream infections with Gram-negative organisms (CRO and Carbapenem sensitive-organisms) in children with malignancy ≤14 years of age from August 2017 to July 2021 were retrieved. The outcome was determined as survival and all-cause death 28 days after the date of Bloodstream infection (BSI) onset.

Sixty-four Gram-negative BSI were identified, with 24% (n=15) in the Carbapenem-Resistant Bloodstream Infection (CR-BSI) group and 76% (n=49) in the Carbapenem-sensitive-Bloodstream Infection group. The patients included 35 males (64%) and 20 females (36%), with ages ranging from 1 year to 14 years (median age: 6.2 y). The most common underlying disease was hematologic malignancy (92.2%, n=59). Children with CR-BSI had a higher incidence of prolonged neutropenia, septic shock, pneumoniae, enterocolitis, altered consciousness, and acute renal failure and were associated with 28-day mortality in univariate analysis. The most common carbapenem-resistant Gram-negative bacilli isolates were Klebsiella species (47%) and Escherichia coli (33%). All carbapenem-resistant isolates were sensitive to colistin, and 33% were sensitive to Tigecycline. The case-fatality rate was 14% (9/64) in our cohort. The overall 28 days mortality was significantly higher in patients with CR-BSI than in those with Carbapenem-sensitive Bloodstream Infection (28-day mortality: 43.8% vs. 4.2%, P =0.001).

Bacteremia with CRO has higher mortality in children with cancer. Prolonged neutropenia, pneumoniae, septic shock, enterocolitis, acute renal failure, and altered consciousness were predictors of 28-day mortality in carbapenem-resistant septicemia.