Clinical Investigation of Bacteremia in Children with Hemato-Oncologic Diseases

Eun Young Ko; Hyun-ju Kang; Hyo Jin Kwon; Ui Yoon Choi; Jae-Wook Lee; Dong-Gun Lee; Yeon-Joon Park; Nak-Gyun Chung; Bin Cho; Hack-Ki Kim; Jin Han Kang

doi:10.3947/ic.2011.43.2.191

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Ko, Kang, Kwon, Choi, Lee, Lee, Park, Chung, Cho, Kim, and Kang: Clinical Investigation of Bacteremia in Children with Hemato-Oncologic Diseases

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2011; 43(2): 191-197.

Published online: 30 April 2011

DOI: https://doi.org/10.3947/ic.2011.43.2.191

Clinical Investigation of Bacteremia in Children with Hemato-Oncologic Diseases

Eun Young Ko¹, Hyun-ju Kang¹, Hyo Jin Kwon¹, Ui Yoon Choi¹, Jae-Wook Lee¹, Dong-Gun Lee²

, Yeon-Joon Park³, Nak-Gyun Chung¹, Bin Cho¹, Hack-Ki Kim¹, Jin Han Kang¹

¹Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.

²Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

³Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Correspondence to Jin Han Kang, M.D. Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, 505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-2828, Fax: +82-2-537-4544, kjhan@catholic.ac.kr

Received 16 August 2010 Revised 23 February 2011 Accepted 24 February 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The purpose of this study was to determine the spectrum of locally prevalent pathogens and their susceptibility patterns responsible for bacteremia in pediatric hemato-oncologic patients for empiric antimicrobial therapy.

Materials and Methods

A one-year retrospective study of pediatric hematooncologic patients with bacteremia in Seoul St. Mary's Hospital, the Catholic University of Korea, from April 2009 to March 2010 was conducted using previous medical records. The findings were compared with our previous data obtained from 2004 to 2006.

Results

Sixty-five episodes of bacteremia were recorded in 41 patients. Of them, 55 (84.6%) occurred in neutropenic and 10 (15.4%) in non-neutropenic patients. Gram-positive organisms were more commonly isolated than Gram-negative organisms (56.9% vs. 41.5%) in the following order: viridans streptococci (23.1%), Klebsiella pneumoniae (21.6%), coagulase-negative staphylococci (12.3%), Staphylococcus aureus (7.7%), Enterococcus faecium (7.7%). Susceptibility rates of viridans streptococci to penicillin, cefotaxime and vancomycin were 33.3%, 60% and 100%, and those of Enterobacteriaceae to amikacin, ceftazidime, piperacillin/ tazobactam and meropenem were 94.7%, 73.7%, 78.9%, and 100%, respectively. Compared to our previous data, infection still contributed towards a major fraction of mortality and morbidity in the management of patients with cancer. No differences in mortality rate were observed between isolated organisms from bacteremia.

Conclusions

Gram-positive organisms were more prevalent than Gram-negative organisms in our population. The monitoring of causative agents and antimicrobial resistance should be considered in therapeutic strategies of pediatric hemato-oncologic infection.

Keywords: Bacteremia, Antimicrobial susceptibility, Child, Neutropenia

Figures and Tables

Figure 1

Percentage of Gram-positive, Gram-negative bacteria and fungus isolated from blood stream infections during years of 2004-2006 versus years of 2009-2010

Table 1

Characteristics of 41 Pediatric Hemato-Oncologic Patients with Bacteremia

^aincludes germinoma

^bincludes aplastic anemia, chronic idiopathic thrombocytopenic purpura, Evans syndrome

Table 2

Causative Organisms in 65 Episodes of Bacteremia Developed in Pediatric Hemato-Oncologic Patients with or without Neutropenia

^aincludes Streptococcus pyogenes and Corynebacterium

^bincludes Raoultella planticola, Ralstonia mannitolilytica, Non-fermenting Gram-negative rods

CNS, Coagulase-negative staphylococci; spp., species

Table 3

Causative Organisms in 65 Episodes of Bacteremia Developed in Pediatric Hemato-Oncologic Patients with or without Catheter

^aincludes Streptococcus pyogenes and Corynebacterium

^bincludes Raoultella planticola, Ralstonia mannitolilytica, Non-fermenting Gram-negative rods

CNS, Coagulase-negative staphylococci; spp., species

Table 4

Antimicrobial Susceptibility Patterns of the Gram-positive Bacterial Isolates

^aincludes Streptococcus pyogenes and Corynebacterium

CNS, Coagulase-negative staphylococci; spp., species

Table 5

Antimicrobial Susceptibility Patterns of the Gram-negative Bacterial Isolates

^aincludes S. malthophilia, Raoultella planticola, Ralstonia mannitolilytica, Non-fermenting gram negative rods

Pip/taz, piperacillin/tazobactam; spp., species

Table 6

Severe Morbidity and Mortality in Pediatric Hemato-Oncologic Patients

CVC, central venous catheter; ICU, intensive care unit

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ORCID iDs: Dong-Gun Lee
https://orcid.org/http://orcid.org/0000-0003-4655-0641
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