Bacteria causing bacteremia in pediatric cancer patients presenting with febrile neutropenia—species distribution and susceptibility patterns
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Infections are a major cause of morbidity and mortality in pediatric cancer patients. The aim of this study was to establish the microbiological spectrum and the susceptibility patterns of bacteremia-causing bacteria in pediatric cancer patients with febrile neutropenia in relation to the use of prophylactic and empirical antibiotics.
We analyzed positive blood cultures of pediatric cancer patients presenting with febrile neutropenia between 2004 and 2011 in Groningen and Amsterdam (the Netherlands) and in Bern (Switzerland), using different antibiotic prophylactic and empirical regimens.
A total of 156 patients with 202 bacteremias, due to 248 bacteria species, were enrolled. The majority (73 %) of bacteremias were caused by Gram-positive bacteria. Gram-negative bacteria, especially Pseudomonas aeruginosa, were observed significantly more often in Bern, where no fluoroquinolone prophylaxis was used. Ciprofloxacin-resistant bacteria were cultured more often from patients who did receive ciprofloxacin prophylaxis, compared to the patients who did not (57 versus 11 %, p = 0.044).
Gram-positive bacteria predominated in this study. We showed that the use of prophylactic antibiotics in pediatric cancer patients was associated with increased resistance rates, which needs further study. The strategy for empiric antimicrobial therapy for febrile neutropenia should be adapted to local antibiotic resistance patterns.
KeywordsChildren Cancer Febrile neutropenia Bacteremia Susceptibility
We would like to thank Daria G. Valerio, Danique van Vliet, Sorina Kramps, Martina Raphael, and Patrizia Minz for collecting parts of the data. The work of KGE Miedema was supported by the Dutch ODAS foundation
Conflict of Interest
- 5.Gafter-Gvili A, Fraser A, Paul M, Vidal L, Lawrie TA, van de Wetering MD, et al. (2012) Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev (4):CD004386Google Scholar
- 7.Hann I, Viscoli C, Paesmans M, Gaya H, Glauser M, International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC) (1997) A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. Br J Haematol 99(3):580–588CrossRefGoogle Scholar
- 9.Greenberg D, Moser A, Yagupsky P, Peled N, Hofman Y, Kapelushnik J et al (2005) Microbiological spectrum and susceptibility patterns of pathogens causing bacteraemia in paediatric febrile neutropenic oncology patients: comparison between two consecutive time periods with use of different antibiotic treatment protocols. Int J Antimicrob Agents 25(6):469–473CrossRefGoogle Scholar
- 14.Nethmap (2011) Available at: http://www.swab.nl/swab/cms3.nsf/uploads/35ACD3A546C31716C12578BF002EDC4F/$FILE/NethMap2011.pdf. Accessed 20 Jan 2012