#31 Bloodstream Infections and Microbiology during Induction Chemotherapy over a Decade at a Community Pediatric Cancer Center

Abstract

Abstract Background Bloodstream infections (BSIs) remain a significant cause of morbidity and mortality in children with leukemia. They are at an increased risk of infectious complications secondary to intense chemotherapeutic regimens during induction resulting in prolonged and profound neutropenia. To our knowledge, there is limited literature regarding pathogens and antibiotic resistance from smaller institutions similar to ours. The primary objective of this review was to describe the microbiology of BSIs, and second to evaluate our rates of BSIs during induction chemotherapy as compared to larger institutions. Method Retrospective chart review of 82 eligible patients between the age of 1 and 21 years with newly diagnosed leukemia between May 1, 2010 and May 31, 2020. Patients who did not complete the entirety of induction chemotherapy at our hospital were excluded. A microbiologically documented infection was defined as a causative pathogen isolated from the blood in the setting of fever and/or neutropenia. Neutropenia was defined as an absolute neutrophil count (ANC) of less than 0.5x109 cells/L. Results Of the 82 patients, 12 (14.6%) patients had a BSI during induction chemotherapy. The most common organisms identified were Gram-positive cocci (75%), Gram-negative bacilli (16.6%), and Gram-negative cocci (8.3%). Methicillin-susceptible Staphylococcus aureus (MSSA) was the most frequently isolated organism (42%) overall. No methicillin-resistant Staphylococcus aureus (MRSA) was identified. Of the Gram-negative bacteria isolated, Escherichia coli (8%) and Pseudomonas aeruginosa (8%) were identified. No extended spectrum beta-lactamase (ESBL) or multi-drug resistant organisms were identified. No fungi were isolated. Conclusion The incidence of BSIs in children during induction chemotherapy at our institution is similar to what is reported from larger, academic centers. Gram-positive cocci comprise 75% of BSIs with no MRSA isolates in 10 years. Our antibiogram shows no resistant Gram-negative bacteria. This is in contrast to what is reported to larger pediatric cancer centers. Therefore, current empiric monotherapy with a fourth generation cephalosporin at the onset of febrile neutropenia remains adequate for our pediatric oncology patients.