Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study

Ji Eun Kang; Joon Young Seok; Ki Wook Yun; Hyoung Jin Kang; Eun Hwa Choi; Kyung Duk Park; Hee Young Shin; Hoan Jong Lee; Hyo Seop Ahn

doi:10.0000/kjpid.2012.19.3.131

Journal List > Korean J Pediatr Infect Dis > v.19(3) > 1096061

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Kang, Seok, Yun, Kang, Choi, Park, Shin, Lee, and Ahn: Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study

Original Article

Korean Journal of Pediatric Infectious Diseases

Korean Journal of Pediatric Infectious Diseases 2012; 19(3): 131-140.

Published online: 31 December 2012

DOI: https://doi.org/10.0000/kjpid.2012.19.3.131

Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study

Ji Eun Kang, M.D.^*, Joon Young Seok, M.D.^*, Ki Wook Yun, M.D.^*,^†, Hyoung Jin Kang, M.D.^*,^†, Eun Hwa Choi, M.D.^*,^†, Kyung Duk Park, M.D.^*,^†, Hee Young Shin, M.D.^*,^†, Hoan Jong Lee, M.D.^*,^†, Hyo Seop Ahn, M.D.^*,^†

^*Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

^†Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author (eunchoi@snu.ac.kr)

Received 23 April 2012 Revised 17 July 2012 Accepted 24 July 2012

Abstract

Purpose

This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy.

Methods

A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted.

Results

A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9%). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6% vs. 22.0%, P=0.04).

Conclusion

This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.

Keywords: Bacteremia, Pediatric cancer, Neutropenia, Fever

Figures and Tables

Fig. 1

Percentage of each pathogens during years of 2002-2005 versus years of 2006-2010.

Fig. 2

Proportion of gram-positive, gram-negative bacteria and fungus isolated from bloodstream infections during years of 2002-2005 versus years of 2006-2010.

Table 1

Characteristics of 176 Pediatric Cancer Patients with Bloodstream Infection

^*Includes Ewing sarcoma, Wilms tumor, yolk sac tumor of testis, rhabdoid tumor of kidney, mixed germ cell tumor, malignant germ cell tumor, extragonadal germ cell tumor, diffuse astrocytoma, desmoplastic small round cell tumor, clear cell sarcoma of kidney, brainstem glioma

^†Includes aplastic anemia, myelodysplastic syndrome

Table 2

Causative Organisms in 226 Episodes of Bloodstream Infections Developed in Pediatric Cancer Patients with or without Neutropenia

^*Includes Corynebacterium species, Lactobacillus species, Streptococcus dysagalactiae, Streptococcus salivarius, Streptococcus species group G, Bacillus species

^†Includes Citrobacter freundii, Kluyvera ascorbata, Moraxella catarrhalis, Neisseria species, Raoultella ornithologica, Serratia marcescens, Sphingomonas paucimobilis, Achromobacter xylosoxidans, Burkholderia cepacia, Elizabethkingia meningosepticum, Hemophilus species, Hafnia alvei, Salmonella species

Table 3

Antibiotic Susceptibilities of Gram-Positive Bacterial Isolates from Bloodsream Infections

^*Includes Bacillus species, Corynebacterium species, Lactobacillus species, Streptococcus dysgalactiae, Streptococcus.salivarius, Streptococcus Group G

Table 4

Antibiotic Susceptibilities of Gram-Negative Bacterial Isolates from Bloodstream Infections

^*Includes Citrobacter freundii, Kluyvera ascorbata, Moraxella catarrhalis, Neisseria species, Raoultella ornithologica, Serratia marcescens, Sphingomonas paucimobilis, Achromobacter xylosoxidans, Burkholderia cepacia, Elizabethkingia meningosepticum, Hemophilus species, Hafnia alvei, Salmonella species

Table 5

Severe Morbidity and Mortality in Pediatric Cancer Patients with Bloodstream Infections

^*Includes Bacillus subtilis, Corynebacterum species, Streptococcus dysgalactiae, Streptococcus salivarius, Streptococcus sanguinis, Streptococcus species Group G

^†Includes Achromobacter xylosoxidans, Burkholderia cepacia, Citrobacter freundii, Haemophilus influenzae, Hafnia alvei, Kluyvera ascorbata, Moraxella catarrhalis, Neisseria species, Raoultella ornitholytica, Salmonella species, Serratia marcescens, Sphingomonas paucimobilis

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