The Pattern of Microorganisms and Drug Susceptibility in Pediatric Oncologic Patients with Febrile Neutropenia

Objective. The study aimed to describe the pattern of causative microorganisms, drug susceptibility, risk factors of antibiotic-resistant bacterial infection, and clinical impact of these organisms on pediatric oncology patients with febrile neutropenia. Methods. A retrospective descriptive study of oncologic patients aged less than 15 years who were diagnosed with febrile neutropenia in King Chulalongkorn Memorial Hospital was conducted between January 2013 to December 2017. Characteristics and clinical outcomes of febrile neutropenia episodes, causative pathogens, and their antibiotic susceptibilities were recorded. Result. This study included 267 patients with 563 febrile neutropenia episodes. The median (range) age was 5.1 years (1 month–15 years). The most common underlying disease was acute lymphoblastic leukemia (42.7%). Of 563 febrile episodes, there were 192 (34.1%) with microbiologically documented infection. Among these 192 episodes of microbiologically documented infection, there were 214 causative pathogens: 154 bacteria (72%), 32 viruses (15%), 27 fungus (12.6%), and 1 Mycobacterium tuberculosis (0.4%). Gram-negative bacteria (48.6%) accounted for most of the causative pathogens. Twenty-three percent of them were multidrug resistant, and 18% were carbapenem resistant. Among Gram-positive bacterial infection which accounted for 23.4% of all specimens, the proportion of MRSA was 20%. The 2-week mortality rate was 3.7%. Drug-resistant Gram-negative bacterial infection caused significant adverse events and mortality compared to nonresistant bacterial infection ( p < 0.05 ). Conclusion. There is high rate of drug-resistant organism infection in pediatric oncology patients in a tertiary-care center in Thailand. Infection with drug-resistant Gram-negative bacterial infection was associated with significant morbidity and mortality. Continuous surveillance for the pattern of drug-resistant infections is crucial.

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Spectrum of systemic bacterial infections during febrile neutropenia in pediatric oncology patients in tertiary care pediatric center

Indian Journal of Cancer ◽

10.4103/0019-509x.175367 ◽

2014 ◽

Vol 51 (4) ◽

pp. 403 ◽

Cited By ~ 7

Author(s):

Sirisharani Siddaiahgari ◽

A Manikyam ◽

KAnand Kumar ◽

A Rauthan ◽

R Ayyar

Keyword(s):

Febrile Neutropenia ◽

Pediatric Oncology ◽

Bacterial Infections ◽

Tertiary Care ◽

Oncology Patients ◽

Pediatric Center

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Re-thinking treatment strategies for febrile neutropenia in paediatric oncology population: the perspective from a developing country

Infectious Agents and Cancer ◽

10.1186/s13027-021-00387-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Vinson James ◽

Anand Prakash ◽

Kayur Mehta ◽

Tarangini Durugappa

Keyword(s):

Escherichia Coli ◽

Drug Resistance ◽

Febrile Neutropenia ◽

Tertiary Care ◽

Automated System ◽

Multi Drug Resistance ◽

Coagulase Negative Staphylococcus ◽

Drug Resistant ◽

Gram Positive ◽

Gram Negative

Abstract Background This study was conducted to evaluate the microbiological profile of bacterial isolates in febrile neutropenia in a pediatric oncology unit, thereby, reviewing the use of restricted antibiotics and need for aggressive medical treatment accordingly. Methods A prospective observational study was conducted in a paediatric haemat-oncology division of a tertiary care teaching hospital in southern India from September 2014 to August 2016. One hundred and thirty children with febrile neutropenia were enrolled in the study. Blood cultures were performed using automated system. Cultures from other sites were obtained if needed, based on the clinical profile. Standard antibiotic susceptibility testing was done. Statistical analysis was done using SPSS. Results One hundred and thirty children were enrolled for the study. Two hundred and fifty episodes of febrile neutropenia were studied. Three hundred and eighty four cultures were sent and 92 (24%) cultures were positive. There were 48 (52.2%) Gram negative isolates followed by 33 (35.8%) Gram positive isolates, six (6.5%) fungal isolates and five (5.5%) poly-microbial cultures. Lactose fermenting Gram negative bacilli (20 isolates, 31.5%) were the most frequently isolated in the Gram negative group, with Escherichia coli being the most common organism (19 isolates, 20.6%). Amongst the Gram positive coagulase negative staphylococcus was the most common (twenty seven isolates, 29%). Escherichia coli and Non lactose fermenting gram negative bacteria (NFGNB) had only 36, 25% sensitivity to ceftazidime, respectively. Most Gram negative bacilli were found to have better sensitivity to amikacin (mean: 57%). There was a higher prevalence of extended spectrum beta lactamase producing organisms. Pan drug resistance, Extreme drug resistance and Multi drug resistance was found in three, twenty and thirteen Gram negative isolates respectively.Escherichia coli and Klebsiella were often drug resistant. Significantly higher mortality was associated with Gram negative isolates (eight deaths out of the thirteen deaths, 61.5%). Conclusions Our results show the importance of surveillance, monitoring resistance frequencies and identifying risk factors specific to each region. Given that significant mortality is attributed to drug resistant Gram negative bacilli, early initiation of appropriate antibiotics to cover for drug resistance is required while formulating empirical antibiotic policies for febrile neutropenia in the oncology units in the developing world.

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Profile of febrile neutropenia in pediatric oncology patients in a tertiary care centre

Pediatric Hematology Oncology Journal ◽

10.1016/j.phoj.2021.04.172 ◽

2020 ◽

Vol 5 (4) ◽

pp. S58-S59

Author(s):

Sunitha Ramaswamy ◽

Julius Scott ◽

Dhaarani Jayaraman ◽

Vidya Krishna ◽

Uma Sekar ◽

...

Keyword(s):

Febrile Neutropenia ◽

Pediatric Oncology ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Oncology Patients

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Re-thinking treatment strategies for febrile neutropenia in paediatric oncology population: A perspective from a developing country.

10.21203/rs.3.rs-23053/v1 ◽

2020 ◽

Author(s):

Vinson James ◽

Anand Prakash ◽

Kayur Mehta ◽

Tarangini Durugappa

Keyword(s):

Escherichia Coli ◽

Drug Resistance ◽

Febrile Neutropenia ◽

Tertiary Care ◽

Automated System ◽

Multi Drug Resistance ◽

Gram Negative Bacteria ◽

Drug Resistant ◽

Gram Positive ◽

Gram Negative

Abstract Background: This study was conducted to evaluate the microbiological profile of bacterial isolates in febrile neutropenia in a pediatric oncology unit, thereby, reviewing the use of restricted antibiotics and need for aggressive medical treatment accordingly.Methods: A prospective observational study was conducted in a paediatric haemat-oncology division of a tertiary care teaching hospital in southern India from September 2014 to August 2016. Children with febrile neutropenia were enrolled in the study. Blood cultures were performed using automated system. Cultures from other sites were obtained if needed, based on the clinical profile. Standard antibiotic susceptibility testing was done. Statistical analysis was done using SPSS.Results: One hundred and thirty children were enrolled for the study. Two hundred and fifty episodes of febrile neutropenia were studied. Three hundred and eighty four cultures were sent and 92 (24%) cultures were positive. There were 52.2% gram negative isolates followed 35.8% gram positive isolates, 6.5% fungal isolates and 5.5% poly-microbial cultures. Lactose fermenting gram negative bacteria (29 isolates, 31.5%) were the most frequently isolated in the gram negative group, with Escherichia coli being the most common organism (19 isolates, 20.6%). Amongst gram positive coagulase negative staphylococcus (CONS) was the most common (29%). Escherichia coli and NFGNB had only 36%, 25% sensitivity to ceftazidime respectively. Most gram negative bacteria were found to have better sensitivity to amikacin (mean: 57). There was a higher prevalence of extended spectrum beta lactamase producing organisms. 36 out of 48 GNB were found to be either multi/extremely/pan drug resistant. Escherichia coli and Klebsiella were often drug resistant. Significantly higher mortality was associated with gram negative isolates (61.5%)Conclusions: In view of higher prevalence of gram negative isolates and emergence of multi drug resistance, frequent audits of resistance patterns should guide the choice of antimicrobials in febrile neutropenia management. Our results show the importance of surveillance, monitoring resistance frequencies and identifying risk factors specific to each region. Given that significant mortality is attributed to drug resistant gram negative bacteria, early initiation of appropriate antibiotics to cover for drug resistance is required while formulating empirical antibiotic policies for febrile neutropenia in the oncology units in the developing world.

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Re-thinking Treatment Strategies for Febrile Neutropenia in Paediatric Oncology Population: A Perspective from a Developing Country

10.21203/rs.3.rs-147823/v1 ◽

2021 ◽

Author(s):

Vinson James ◽

Anand Prakash ◽

Kayur Mehta ◽

Tarangini Durugappa

Keyword(s):

Escherichia Coli ◽

Drug Resistance ◽

Febrile Neutropenia ◽

Tertiary Care ◽

Automated System ◽

Multi Drug Resistance ◽

Gram Negative Bacteria ◽

Drug Resistant ◽

Gram Positive ◽

Gram Negative

Abstract Background: This study was conducted to evaluate the microbiological profile of bacterial isolates in febrile neutropenia in a pediatric oncology unit, thereby, reviewing the use of restricted antibiotics and need for aggressive medical treatment accordingly. Methods: A prospective observational study was conducted in a paediatric haemat-oncology division of a tertiary care teaching hospital in southern India from September 2014 to August 2016. Children with febrile neutropenia were enrolled in the study. Blood cultures were performed using automated system. Cultures from other sites were obtained if needed, based on the clinical profile. Standard antibiotic susceptibility testing was done. Statistical analysis was done using SPSS.Results: One hundred and thirty children were enrolled for the study. Two hundred and fifty episodes of febrile neutropenia were studied. Three hundred and eighty four cultures were sent and 92 (24%) cultures were positive. There were 52.2% gram negative isolates followed 35.8% gram positive isolates, 6.5% fungal isolates and 5.5% poly-microbial cultures. Lactose fermenting gram negative bacteria (29 isolates, 31.5%) were the most frequently isolated in the gram negative group, with Escherichia coli being the most common organism (19 isolates, 20.6%). Amongst gram positive coagulase negative staphylococcus (CONS) was the most common (29%). Escherichia coli and NFGNB had only 36%, 25% sensitivity to ceftazidime respectively. Most gram negative bacteria were found to have better sensitivity to amikacin (mean: 57). There was a higher prevalence of extended spectrum beta lactamase producing organisms. 36 out of 48 GNB were found to be either multi/extremely/pan drug resistant. Escherichia coli and Klebsiella were often drug resistant. Significantly higher mortality was associated with gram negative isolates (61.5%)Conclusions: In view of higher prevalence of gram negative isolates and emergence of multi drug resistance, frequent audits of resistance patterns should guide the choice of antimicrobials in febrile neutropenia management. Our results show the importance of surveillance, monitoring resistance frequencies and identifying risk factors specific to each region. Given that significant mortality is attributed to drug resistant gram negative bacteria, early initiation of appropriate antibiotics to cover for drug resistance is required while formulating empirical antibiotic policies for febrile neutropenia in the oncology units in the developing world.

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New guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients

Jornal de Pediatria ◽

10.2223/jped.1624 ◽

2007 ◽

Vol 83 (7) ◽

pp. 54-63 ◽

Cited By ~ 24

Author(s):

Ana Verena Almeida Mendes ◽

Roberto Sapolnik ◽

Núbia Mendonça

Keyword(s):

Febrile Neutropenia ◽

Pediatric Oncology ◽

Clinical Management ◽

Oncology Patients ◽

New Guidelines

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Extensively drug-resistant and pandrug-resistant Gram-negative bacteria in a tertiary-care hospital in Eastern India: A 4-year retrospective study

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2018.08.010 ◽

2018 ◽

Vol 15 ◽

pp. 246-249 ◽

Cited By ~ 6

Author(s):

Debi Prasad Mohapatra ◽

Nagen Kumar Debata ◽

Santosh Kumar Singh

Keyword(s):

Retrospective Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Gram Negative Bacteria ◽

Care Hospital ◽

Drug Resistant ◽

Eastern India ◽

Gram Negative ◽

Extensively Drug Resistant

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Prevalence and Characterization of Multi Drug Resistant Gram Negative Bacilli Isolates from a Tertiary Care Centre of Western U.P., India

Journal of Pure and Applied Microbiology ◽

10.22207/jpam.13.2.45 ◽

2019 ◽

Vol 13 (2) ◽

pp. 1069-1078

Author(s):

Shivendra Mohan ◽

Umar Farooq

Keyword(s):

Tertiary Care ◽

Drug Resistant ◽

Care Centre ◽

Tertiary Care Centre ◽

Gram Negative

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

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa170.048 ◽

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.

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