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The changing epidemiology of bacteremia in neutropenic children with cancer
V M Aquino1, A Pappo, G R Buchanan
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063, USA.
Insights
Gram-negative bacteria are increasingly causing bacteremia in pediatric cancer patients, shifting from a previous predominance of Gram-positive organisms. This change may impact initial antibiotic choices for these vulnerable young patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Bacteriology
Background:
- Gram-positive bacteria historically dominated bacteremia in febrile neutropenic cancer patients.
- Recent observations indicated a rise in Gram-negative bacteremia among pediatric cancer patients.
Purpose of the Study:
- To investigate the changing etiology of bacteremia in pediatric oncology patients over a six-year period.
- To analyze shifts in bacterial isolates causing bloodstream infections in children and adolescents with cancer.
Main Methods:
- Retrospective review of 153 episodes of bacteremia.
- Comparison of bacterial isolates from two distinct 3-year periods (1988-1990 vs. 1991-1993).
Main Results:
- Gram-positive organisms accounted for 74% of isolates in the early period (1988-1990), with Staphylococcus epidermidis being most common.
- Gram-negative organisms significantly increased to 50% of isolates in the later period (1991-1993) (P = 0.004).
- Pseudomonas aeruginosa emerged as the most frequent isolate (22%) during the later period.
Conclusions:
- A significant epidemiological shift in bacteremia etiology occurred in pediatric cancer patients, with Gram-negative bacteria becoming more prevalent.
- This alteration may necessitate adjustments in empiric antibiotic therapy for febrile neutropenic children and adolescents with cancer.
- Changes in chemotherapy intensity might be influencing this epidemiological transition.
Abstract:
Gram-positive bacteria have been the predominant organisms causing bacteremia in febrile neutropenic cancer patients during the past decade. Recently we have noted an increase in Gram-negative bacteremia in children and adolescents with cancer. Therefore we retrospectively reviewed 153 episodes of bacteremia during a 6-year period to investigate changes in the etiology of bacteremia in pediatric oncology patients. In the early 3-year period (January, 1988, to December, 1990) Gram-positive organisms comprised 73 (74%) of the 99 isolates, and Staphylococcus epidermidis was the most common isolate. In the later 3-year period (January, 1991, to December, 1993) Gram-negative organisms were seen with greater frequency and represented 50% of isolates (P = 0.004). Pseudomonas aeruginosa was the most commonly isolated organism during this period (22% of all isolates). We speculate that the recent utilization of more intensive chemotherapy regimens has caused an alteration in the epidemiology of bacteremia in children and adolescents with cancer which could influence the initial empiric antibiotic regimens and the outcome of such infections.