Multidrug-Resistant Gram-Negative Bacteremia among Pediatric Oncology Patients with Neutropenic Fever: Associated...

Children with cancers remain at a high risk of mortality due to infection, compounded by rising rates of multidrug-resistant Gram-negative bacteria (MDR-GNB), particularly in developing countries. This study aimed to determine the occurrence of bacteremia caused by MDR-GNB and identify the associated risk factors and the clinical outcomes.

A retrospective cohort study was conducted using medical records from children with cancers aged 0-18 years at Dr. Sardjito Hospital, a tertiary care center in Indonesia, between 2020 and 2024. Patients with neutropenic fever and bacteremia were enrolled in the analysis. Multivariate logistic regression was used to analyze the associated factors of bacteremia caused by MDR-GNB, while Cox regression analysis was utilized to assess the outcomes of 30-days mortality rate.

A total of 63 cases were included. MDR-GNB was identified in 28.6% (18/63) of patients, representing 52.9% (18/34) of all Gram-negative bacteremia. Most patients had hematologic malignancies (87.2%), with a median absolute neutrophil count (ANC) of 60 cells/mm³ (interquartile range: 0-320). The predominant pathogens were Escherichia coli (66.7%) and Klebsiella pneumoniae (16.7%). Multivariate analysis revealed that ANC <100 cells/mm³ (adjusted odds ratio [aOR], 5.8; 95% confidence interval [CI], 1.1-30.1; P=0.038) and cytostatic administration within the preceding week (aOR, 6.0; 95% CI, 1.04-35.1; P=0.045) were significant risk factors for MDR-GNB bacteremia. Furthermore, MDR-GNB infection was associated with a significantly increased risk of septic shock (hazard ratio [HR], 4.4; 95% CI, 1.2-15.4; P=0.021) and 30-day mortality (HR, 9.5; 95% CI, 2.4-37.6; P=0.001).

Children with cancers and neutropenic fever should be carefully evaluated for MDR-GNB infection, particularly if the ANC was low and cytostatics were administered within the past week. Comprehensive strategies are essential to mitigate the risks of mortality among pediatric patients with MDR-GNB.