scholarly journals 194. Antibiotic-resistant bloodstream infections in pediatric oncology patients on levofloxacin prophylaxis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S102-S102
Author(s):  
Sunita Sridhar ◽  
Anurag K Agrawal ◽  
Lauren Ferrerosa ◽  
Brian Lee ◽  
Prachi Singh
Keyword(s):  
Antibiotic Resistance ◽  
Pediatric Oncology ◽  
Case Series ◽  
Bloodstream Infections ◽  
Published Data ◽  
Close Monitoring ◽  
Oncology Patients ◽  
Antibiotic Resistant ◽  
Viridans Streptococcus ◽  
Levofloxacin Prophylaxis

Abstract Background Levofloxacin prophylaxis in pediatric oncology patients with chemotherapy-induced severe prolonged neutropenia has been shown to reduce risk for febrile neutropenia and systemic infections. With increased use of prophylaxis there is concern for development of antibiotic-resistant infections. We analyzed bloodstream infections (BSI) in pediatric oncology patients exposed to levofloxacin prophylaxis during prolonged severe neutropenic episodes to determine the rate of antibiotic resistance Methods We performed a retrospective chart review of pediatric oncology patients who received levofloxacin prophylaxis between January 2015 – December 2019. Patients were placed on levofloxacin prophylaxis based on institutional guidelines for patients at risk for severe prolonged neutropenia (i.e., absolute neutrophil count [ANC] < 500 cells/µL for >7 days). Demographic information, start and end dates for levofloxacin prophylaxis, and all BSI episodes within 2 months after exposure to the fluoroquinolone were collected Results Thirty-five patients were identified who received levofloxacin prophylaxis. There were 32 BSI in 12 patients. Twenty-five BSI involved gram-positive organisms (GP), including nine (36%) due to coagulase negative Staphylococcus and seven (28%) due to viridans Streptococcus. Seven BSI episodes involved gram-negative (GN) organisms with 4 (57%) from E.coli. Resistance to fluroquinolones was noted in 42% and 48% of BSI from GN and GP organisms respectively. The vast majority (85%) of viridans Streptococcus isolates were resistant to levofloxacin. In contrast, 8% of viridans Streptococcus isolates were resistant to fluoroquinolones from the same time frame per our hospital antibiogram. Conclusion In this recent cohort of pediatric oncology patients with BSI after exposure to levofloxacin prophylaxis, there was a high percentage infected with fluoroquinolone-resistant organisms.This contrasts with some of the earlier published data from adults which reported low rate of fluoroquinolone resistance. This case series highlights the need for close monitoring for development of antibiotic resistance as utilization of prophylactic levofloxacin increases in pediatric oncology patients. Disclosures All Authors: No reported disclosures

#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S16
Author(s):  
Miguel A Minero ◽  
Asia Castro ◽  
Martha Avilés-Robles
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

scholarly journals 580. Association Between Central Venous Catheter Repair and Bloodstream Infections in a Pediatric Oncology Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S274-S274
Author(s):  
Ruba Barbar ◽  
Hana Hakim ◽  
Patricia Flynn ◽  
Aditya H Gaur ◽  
Darenda Wright ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Pediatric Population ◽  
Healthcare Delivery ◽  
Significant Risk ◽  
Bloodstream Infections ◽  
Categorical Variables ◽  
Central Venous ◽  
Oncology Patients ◽  
Increased Risk ◽  
Oncology Center

Abstract Background Central venous catheters (CVCs) are important for healthcare delivery in pediatric oncology patients. It is common to repair CVC breakage to prevent replacement. Existing evidence regarding the association between CVC repair and bloodstream infections (BSI) is limited in the general pediatric population and lacking in pediatric oncology patients. We aim at evaluating whether repairing broken CVCs is associated with an increased risk for subsequent BSI in a pediatric oncology center. Methods This is a retrospective case-crossover study of pediatric oncology patients with broken CVCs that underwent repair between July 2015 and June 2017. The incidence and characteristics of BSI in the 30-day pre-repair period were compared with those in the 30-day post-repair period. Wilcoxon-Mann–Whitney and Fisher’s Exact tests were used for comparison of continuous and categorical variables, respectively. Univariate logistic regression was used to identify potential risk factors for BSI post CVC repair. Multiple breakages of the same CVC, and BSIs in overlapping observation periods of consecutive breakages are assumed independent. Results Sixty-four patients had 99 episodes of CVC breakage/repair in 68 CVCs. Median age (range) at repair was 2.5 (0.15–17.6) years. 48% of CVC breakages occurred in patients with solid tumors, 24% in HSCT recipients, and 19% in patients with leukemia. Only 25% of patients had neutropenia at repair and 14% had CVC occlusion 72 hours prior to breakage. All CVCs were made of silicone and 88% were double lumen external tunneled. First CVC breakage occurred at a median (range) of 130 (2–718) days since insertion, and CVCs were removed at a median (range) of 72.5 (3–753) days from the last repair. End of treatment was the most common cause (43%) for removal. The post-repair incidence of BSI was 4.5 per 1000 line-days compared with a pre-repair incidence of 4.3 (RR= 0.95, 95% CI 0.44, 2.18). There is no statistical difference between the characteristics of the pre-repair and post-repair BSI (Table 1). Figure 1 shows the organisms causing BSI before and after CVC repair. None of the evaluated variables was identified as a significant risk factor for BSI 30 days after CVC repair (Table 2). Conclusion Repair of CVC in pediatric oncology patients was not associated with increased risk of BSI. Disclosures All authors: No reported disclosures.

A case‐series of pediatric oncology patients undergoing successful rapid etoposide desensitization

2019 ◽  
Author(s):  
Tara E. Wright ◽  
Mona D. Shah ◽  
Nicholas L. Rider ◽  
Tim J. Porea ◽  
Matthew A. Musick ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Case Series ◽  
Oncology Patients

Ethanol-Lock Technique in the Treatment of Bloodstream Infections in Pediatric Oncology Patients With Broviac Catheter

2003 ◽  
Vol 25 (8) ◽  
pp. 616-621 ◽  
Author(s):  
Claudia Dannenberg ◽  
Uta Bierbach ◽  
Antje Rothe ◽  
Jörg Beer ◽  
Dieter Körholz
Keyword(s):  
Pediatric Oncology ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Ethanol Lock

Diagnosis of Catheter-Related Bloodstream Infections Among Pediatric Oncology Patients Lacking a Peripheral Culture, Using Differential Time to Detection

2005 ◽  
Vol 24 (5) ◽  
pp. 445-449 ◽  
Author(s):  
Aditya H. Gaur ◽  
Patricia M. Flynn ◽  
Daniel J. Heine ◽  
Mary Anne Giannini ◽  
Jerry L. Shenep ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Time To Detection

scholarly journals Bacillus Species Bloodstream Infections Among Pediatric Oncology Patients: When Is Line Removal Really Necessary?

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Sonia Mehra ◽  
Adam L. Hersh ◽  
Anne J. Blaschke ◽  
Chris Stockmann ◽  
Richard Lemons ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Bloodstream Infections ◽  
Bacillus Species ◽  
Oncology Patients

scholarly journals Limiting Vancomycin Exposure in Pediatric Oncology Patients With Febrile Neutropenia May Be Associated With Decreased Vancomycin-Resistant Enterococcus Incidence

2019 ◽  
Vol 9 (4) ◽  
pp. 428-436 ◽  
Author(s):  
Manjiree V Karandikar ◽  
Carly E Milliren ◽  
Robin Zaboulian ◽  
Poornima Peiris ◽  
Tanvi Sharma ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
High Risk ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Antibiotic Use ◽  
Vancomycin Resistant Enterococcus ◽  
Post Intervention ◽  
Oncology Patients ◽  
Vancomycin Resistant ◽  
The Impact

Abstract Background Limited data exists regarding the effects of empiric antibiotic use in pediatric oncology patients with febrile neutropenia (FN) on the development of antibiotic resistance. We evaluated the impact of a change in our empiric FN guideline limiting vancomycin exposure on the development of vancomycin-resistant Enterococcus in pediatric oncology patients. Methods Retrospective, quasi-experimental, single-center study using interrupted timeseries analysis in oncology patients aged ≤18 years with at least 1 admission for FN between 2009 and 2015. Risk strata incorporated diagnosis, chemotherapy phase, Down syndrome, septic shock, and typhlitis. Microbiologic data and inpatient antibiotic use were obtained by chart review. Segmented Poisson regression was used to compare VRE incidence and antibiotic days of therapy (DOT) before and after the intervention. Results We identified 285 patients with 697 FN episodes pre-intervention and 309 patients with 691 FN episodes postintervention. The proportion of high-risk episodes was similar in both periods (49% vs 48%). Empiric vancomycin DOT/1000 FN days decreased from 315 pre-intervention to 164 post-intervention (P < .01) in high-risk episodes and from 199 to 115 in standard risk episodes (P < .01). Incidence of VRE/1000 patient-days decreased significantly from 2.53 pre-intervention to 0.90 post-intervention (incidence rate ratio, 0.14; 95% confidence interval, 0.04–0.47; P = .002). Conclusions A FN guideline limiting empiric vancomycin exposure was associated with a decreased incidence of VRE among pediatric oncology patients. Antimicrobial stewardship interventions are feasible in immunocompromised patients and can impact antibiotic resistance.

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