Bacteremia in Children with Solid Tumors: Etiology, Antimicrobial Susceptibility, Factors Associated with Multidrug Resistance, and Mortality

Amit Ginzburg, Gal Goldstein, Dror Raviv, Hodaya Cohen, Sigal Weinreb, Dan Harlev, Adi Nitsan-Luques, Mohammad Yacoub Abou Saoud, Jacob Strahilevitz, Diana Averbuch

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

This retrospective study aims to describe the etiology and resistance patterns of pathogens causing bacteremia in children with solid tumors in a tertiary pediatric hematology-oncology center in Jerusalem, Israel (2011-2019). Factors associated with multidrug-resistant (MDR) bacteremia and mortality were analyzed. A total of 228 pathogens were isolated in 126 patients; 61.0% were gram-negative rods (GNR) and 38.2% were gram-positive cocci (GPC). The most common pathogens were Klebsiella pneumoniae (19.3%), Escherichia coli (17.5%), and coagulase-negative staphylococci (16.2%). The proportion of MDR-GNR was 18.2%, while the proportion of MDR-GPC was 55.2%. In logistic regression analysis, breakthrough bacteremia on a penicillin-group antibiotic (odds ratio [OR] 5.69, [95% confidence interval 1.42-22.76], p-value = 0.014) was associated and underlying diagnosis of neuroblastoma was inversely associated (OR 0.17, [0.04-0.81], p-value = 0.026) with MDR-GNR bacteremia; while the previous hospitalizations' duration (OR 1.032/day, [1.01-1.06], p-value = 0.007) and oncologic treatment intensity (OR 2.19, [1.08-4.45, p-value = 0.03) were associated with MDR-GPC bacteremia. Shock, prolonged profound neutropenia, and pediatric intensive care unit (PICU) admission were associated with 7-day mortality; and relapsed disease, oncologic treatment intensity, prolonged profound neutropenia, and PICU admission-with 30-day mortality in the univariate analyses. Empirical antibiotic choice should be based on factors associated with MDR infections in this specific population.

Original languageAmerican English
Pages (from-to)601-610
Number of pages10
JournalMicrobial Drug Resistance
Volume28
Issue number5
DOIs
StatePublished - 1 May 2022

Bibliographical note

Publisher Copyright:
© Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.

Keywords

  • bacteremia
  • gram-negative rods
  • gram-positive cocci
  • resistance
  • solid tumors

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