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[Bacteremic episodes in pediatric oncologic patients, especially caused by the Streptococcus viridans group]
Insights
Gram-positive bacteria, particularly viridans streptococci, are the most common cause of bacteremia in pediatric cancer patients, leading to significant morbidity in those with hematological malignancies. Understanding these bacterial patterns is crucial for effective anti-infective treatment in immunocompromised children.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Context:
- Infectious complications significantly impact pediatric cancer patient care.
- Fever of unknown origin is common in neutropenic patients, often without identified pathogens.
- Identifying bacteremic pathogens is vital for guiding anti-infective therapy.
Purpose:
- To retrospectively analyze bacteremic episodes in pediatric oncology patients.
- To determine the spectrum of pathogens and their antibiotic susceptibility.
- To correlate bacteremic episodes with underlying conditions and patient outcomes.
Summary:
- A 10-year analysis of 113 bacteremic episodes in pediatric oncology patients revealed Gram-positive bacteria as predominant (72% in hematological malignancies, 58% in solid tumors).
- Viridans streptococci were the most frequent pathogen in hematological malignancies (35%), associated with severe sepsis and ARDS.
- Gram-negative rods were also prevalent, with favorable antibiotic susceptibility profiles observed for both Gram-positive and Gram-negative isolates.
Impact:
- This study highlights the critical role of Gram-positive bacteria, especially viridans streptococci, in pediatric oncology bacteremia.
- Findings underscore the need for targeted anti-infective strategies based on pathogen prevalence and susceptibility.
- Knowledge of expected bacterial spectrum aids in timely and effective treatment of infections in immunocompromised children.
Background:
The management of infectious complications plays a major role in the care for pediatric cancer patients. The majority of infections in the neutropenic patient present as fever of unknown origin without recovering a pathogen from the blood stream. The careful evaluation of bacteremic episodes is essential, since knowledge of the bacterial spectrum expected is crucial for the successful anti-infective treatment.
Patients And Methods:
From 1985 to 1995 all bacteremic episodes in pediatric oncology patients at the University Children's Hospital Freiburg were retrospectively analyzed with respect to the pathogens encountered, the antibiotic susceptibility profile and the underlying conditions.
Results:
Overall, 113 bacteremic episodes were encountered in pediatric oncology patients, 68 of them in patients with hematological malignancies, and 45 in patients with solid tumors. In both patient groups, gram-positive bacteria were predominant with 72% and 58%, respectively. In patients with hematological malignancies, viridans streptococci were the most frequently isolated pathogens (35%) with a relevant morbidity (29% of patients developed a severe sepsis syndrome and/or ARDS), but were found only in 9% of patients with solid tumors. In 28% of patients with leukemia or lymphoma, gram-negative rods were cultured, in 6% Pseudomonas spec., in 4% Acinetobacter spec., and in 18% enterobacteria. In patients with solid tumors, in 38% gram-negative rods were isolated, 7% Pseudomonas spec., 16% Acinetobacter spec., 16% enterobacteria. In 3 patients, fungemia was observed. The antibiotic susceptibility profile was quite favorable in both, gram-positive and -negative bacteria: none of the gram-positive isolates was resistant to vancomycin, none of the Staphylococcus aureus isolates was resistant to oxacillin. All gram-negative bacteria were fully susceptible to ceftazidime, imipenem and ciprofloxacin.
Conclusion:
Gram-positive bacteria account for 2/3 of all bacteremic episodes in pediatric oncology patients. Streptococcus viridans was the most important pathogen in hematological malignancies accounting for a significant, pathogen-specific morbidity.