Predictors and Outcomes of Multidrug-Resistant Gram-Negative Bacterial Bloodstream Infections in Pediatric Oncology Patients

Abstract

Background Pediatric patients with cancer are at great risk of infection either from disease process or after being immuno-suppressed by chemotherapy and radiotherapy, this is especially with gram negative and multidrug resistant (MDR) pathogens. The primary aim of our study is to detect the frequency of multidrug resistant gram negative bacteria (MDR-GNB) infections at the Pediatric Oncology Department. The secondary aim is to identify the patterns of resistance of different pathogens to commonly used antimicrobials and detect the risk factors and outcomes of MDR-GNB infections in pediatric oncology patients. Patients and Methods We studied episodes of fever and /or bacteremia in children (aged 1 m to 18 y) with hematologic and solid malignancies in the pediatric oncology department in Ain Shams University Hospital between January 2020 and March 2021. We studied different risks for MDR-GNB including sex, age, underlying malignancy, the presence of indwelling catheter, absolute neutrophil count and other laboratory investigations. Results MDR bacteria were isolated in about 15% samples. The most commonly detected MDR-GNB pathogens were Klebsiella (61.1%) and Acintobacter (22.2%). Among studied patients, MDR-GNB were significantly reported among patients with T-lymphoblastic lymphoma (p = 0.006). Although most patients were neutropenic, neutrophil count was not significantly correlated (p = 0.981). Low serum albumin on the other hand was significantly correlated with MDR-GNB (p = 0.009). Conclusion MDR-GNB is a significant threat to pediatric oncology patients. Contact precautions for all patients with colonization or infection with MDR pathogens and an antimicrobial stewardship based on local epidemiology should be implemented to prevent MDR infections.