Abstract
Objective The study aimed to describe the pattern of causative microorganisms, drug susceptibility, risk factors of antibiotic-resistant bacterial infection, and clinical impact of these organisms on pediatric oncology patients with febrile neutropenia. Methods A retrospective descriptive study of oncologic patients aged less than 15 years who were diagnosed with febrile neutropenia in King Chulalongkorn Memorial Hospital was conducted between January 2013 to December 2017. Characteristics and clinical outcomes of febrile neutropenia episodes, causative pathogens, and their antibiotic susceptibilities were recorded. Result This study included 267 patients with 563 febrile neutropenia episodes. The median (range) age was 5.1 years (1 month–15 years). The most common underlying disease was acute lymphoblastic leukemia (42.7%). Of 563 febrile episodes, there were 192 (34.1%) with microbiologically documented infection. Among these 192 episodes of microbiologically documented infection, there were 214 causative pathogens: 154 bacteria (72%), 32 viruses (15%), 27 fungus (12.6%), and 1 Mycobacterium tuberculosis (0.4%). Gram-negative bacteria (48.6%) accounted for most of the causative pathogens. Twenty-three percent of them were multidrug resistant, and 18% were carbapenem resistant. Among Gram-positive bacterial infection which accounted for 23.4% of all specimens, the proportion of MRSA was 20%. The 2-week mortality rate was 3.7%. Drug-resistant Gram-negative bacterial infection caused significant adverse events and mortality compared to nonresistant bacterial infection (p < 0.05). Conclusion There is high rate of drug-resistant organism infection in pediatric oncology patients in a tertiary-care center in Thailand. Infection with drug-resistant Gram-negative bacterial infection was associated with significant morbidity and mortality. Continuous surveillance for the pattern of drug-resistant infections is crucial.
Highlights
Febrile neutropenia is a common treatment-related complication in oncologic pediatric patients with substantial morbidities and mortalities
Febrile neutropenia was defined as fever which has a single oral temperature measurement of ≥38.3°C or a temperature of ≥38.0°C sustained over 1 hour, and neutropenia was identified when the absolute neutrophil count (ANC) was
We found that approximately 40% of E. coli were resistant to third-generation cephalosporin, an increase from our previous studies (34%) and data from the study of the National Antimicrobial Resistant Surveillance, ailand (NARST), which reported a resistance of 30% [4, 17], while it was found that 90% of E. coli were susceptible to piperacillin/tazobactam, amikacin, and carbapenem, which was similar to previous studies in ailand [4, 17]. e percentage of resistance of K. pneumoniae to third-generation cephalosporin was similar to previous studies (30–40%) [4, 17]
Summary
Febrile neutropenia is a common treatment-related complication in oncologic pediatric patients with substantial morbidities and mortalities. Recent studies found that the mortality rate of febrile neutropenic pediatric patients was approximately 0.5–6 percent [1,2,3]. A previous study in King Chulalongkorn Memorial Hospital, ailand, from 2007 to 2009 found that the incidence of febrile neutropenia in pediatric patients per 100 admissions was 21.2 and the mortality rate was 16.6 percent [4]. E previous studies during 2000–2010 showed that the most common isolated pathogens in febrile neutropenic patients were bacteria [2,3,4,5,6]. Previous studies in developed countries found that there has been a shift in the causative microorganisms to Gram-positive bacteria [2, 6, 7, 9, 10] but Gram-negative bacteria continue to be a predominant causative pathogen among developing countries [3,4,5, 11] e previous study during 2007–2009 in ailand reported that the most common pathogens isolated from cultures in pediatric oncologic patients were Gram-negative bacteria (80%) [4]
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