Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer.
Anti-Bacterial Agents
/ therapeutic use
Bacteremia
/ microbiology
Bacteria
Child
Female
Gram-Negative Bacteria
Gram-Negative Bacterial Infections
/ microbiology
Gram-Positive Bacteria
Gram-Positive Bacterial Infections
Hematologic Neoplasms
/ drug therapy
Humans
Male
Neoplasms
/ drug therapy
Retrospective Studies
Risk Factors
Sepsis
/ microbiology
Journal
Journal of pediatric hematology/oncology
ISSN: 1536-3678
Titre abrégé: J Pediatr Hematol Oncol
Pays: United States
ID NLM: 9505928
Informations de publication
Date de publication:
01 Mar 2022
01 Mar 2022
Historique:
received:
16
01
2021
accepted:
23
05
2021
pubmed:
27
7
2021
medline:
20
4
2022
entrez:
26
7
2021
Statut:
ppublish
Résumé
Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment. Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria. Among 224 monomicrobial bacterial BSI episodes, Gram-negative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.7:1) versus boys (Gram-negative/Gram-positive ratio 0.72:1), P=0.002, in patients with previous BSI episodes (1.4:1) versus those without (0.8:1), P=0.042, and in children with hematologic malignancy (1.3:1) versus those who suffered from solid tumors (0.52:1), P=0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P=0.009, neutrophils, P=0.009 and platelets, P=0.002, but with significantly higher C-reactive protein (CRP) levels, P=0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis. Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria.
Sections du résumé
BACKGROUND
BACKGROUND
Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment.
MATERIALS AND METHODS
METHODS
Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria.
RESULTS
RESULTS
Among 224 monomicrobial bacterial BSI episodes, Gram-negative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.7:1) versus boys (Gram-negative/Gram-positive ratio 0.72:1), P=0.002, in patients with previous BSI episodes (1.4:1) versus those without (0.8:1), P=0.042, and in children with hematologic malignancy (1.3:1) versus those who suffered from solid tumors (0.52:1), P=0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P=0.009, neutrophils, P=0.009 and platelets, P=0.002, but with significantly higher C-reactive protein (CRP) levels, P=0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis.
CONCLUSIONS
CONCLUSIONS
Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria.
Identifiants
pubmed: 34310469
doi: 10.1097/MPH.0000000000002253
pii: 00043426-202203000-00023
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e368-e373Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Moskalewicz RL, Isenalumhe LL, Luu C, et al. Bacteremia in nonneutropenic pediatric oncology patients with central venous catheters in the ED. Am J Emerg Med. 2017;35:20–24.
Ammann RA, Laws HJ, Schrey D, et al. Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors. Eur J Pediatr. 2015;174:675–686.
Doganis D, Asmar B, Yankelevich M, et al. Predictive factors for blood stream infections in children with cancer. J Pediatr Hematol Oncol. 2013;30:403–415.
Simon A, Furtwangler R, Graf N, et al. Surveillance of bloodstream infections in pediatric cancer centers—what have we learned and how do we move on? GMS Hyg Infect Control. 2016;11:Doc11.
Bartholomew F, Aftandilian C, Andrews J, et al. Evaluation of febrile, nonneutropenic pediatric oncology patients with central venous catheters who are not given empiric antibiotics. J Pediatr. 2015;166:157–162.
Kebudi R, Kizilocak H. Febrile neutropenia in children with cancer: approach to diagnosis and treatment. Curr Pediatr Rev. 2018;14:204–209.
Lehrnbecher T. Treatment of fever in neutropenia in pediatric oncology patients. Cur Opin Pediatr. 2019;31:35–40.
Lehrnbecher T, Robinson P, Fisher B, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J Clin Oncol. 2017;35:2082–2094.
Babady NE. Laboratory diagnosis of infections in cancer patients: challenges and opportunities. J Clin Microbiol. 2016;54:2635–2646.
Lambregts MMC, Bernards AT, van der Beek MT, et al. Time to positivity of blood cultures supports early re-evaluation of empiric broad-spectrum antimicrobial therapy. PLoS One. 2019;14:e0208819.
Horing S, Massarani AS, Loffler B, et al. Rapid antibiotic susceptibility testing in blood culture diagnostics performed by direct inoculation using the VITEK(R)-2 and BD phoenix platforms. Eur J Clin Microbiol Infect Dis. 2019;38:471–478.
Quiles MG, Menezes LC, Bauab Kde C, et al. Diagnosis of bacteremia in pediatric oncologic patients by in-house real-time PCR. BMC Infect Dis. 2015;15:283–290.
Doganis D, Asmar B, Yankelevich M, et al. How many sources should be cultured for the diagnosis of a blood stream infection in children with cancer? J Pediatr Hematol Oncol. 2013;30:416–424.
Opota O, Jaton K, Greub G. Microbial diagnosis of bloodstream infection: towards molecular diagnosis directly from blood. Clin Microbiol Infects. 2015;21:323–331.
Bae KS, Shin JA, Kim SK, et al. Enterococcal bacteremia in febrile neutropenic children and adolescents with underlying malignancies, and clinical impact of vancomycin resistance. Infection. 2018;47:417–424.
Ciofi Degli Atti M, Bernaschi P, Carletti M, et al. An outbreak of extremely drug-resistant Pseudomonas aeruginosa in a tertiary care pediatric hospital in Italy. BMC Infect Dis. 2014;14:494–501.
Yacobovich J, Ben-Ami T, Abdalla T, et al. Patient and central venous catheter related risk factors for blood stream infections in children receiving chemotherapy. Pediatr Blood Cancer. 2015;62:471–476.
Subburaj D, Uppuluri R, Jayaraman D, et al. Combating blood stream infections during induction chemotherapy in children with acute myeloid leukemia: single center results in India. Pediatr Blood Cancer. 2017;64:1–3.
Bochennek K, Hassler A, Perner C, et al. Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial AML-BFM 2004. Blood Cancer J. 2016;6:e382.
Mvalo T, Eley B, Bamford C, et al. Bloodstream infections in oncology patients at Red Cross War Memorial Children’s Hospital, Cape Town, from 2012 to 2014. Int J Infect Dis. 2018;77:40–47.
Rogers AE, Eisenman KM, Dolan SA, et al. Risk factors for bacteremia and central line-associated blood stream infections in children with acute myelogenous leukemia: a single-institution report. Pediatr Blood Cancer. 2017;64:1–7.
Calton EA, Le Doare K, Appleby G, et al. Invasive bacterial and fungal infections in paediatric patients with cancer: incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009-2011. Pediatr Blood Cancer. 2014;61:1239–1245.
Kitanovski L, Jazbec J, Hojker S, et al. Diagnostic accuracy of lipopolysaccharide-binding protein for predicting bacteremia/clinical sepsis in children with febrile neutropenia: comparison with interleukin-6, procalcitonin, and C-reactive protein. Support Care Cancer. 2014;22:269–277.
Tang Y, Liao C, Xu X, et al. Th1/Th2 cytokine profiles in G+/G- bacteremia in pediatric hematology/oncology patients. Pediatr Blood Cancer. 2012;58:50–54.
Soker M, Colpan L, Ece A, et al. Serum levels of IL-1 beta, sIL-2R, IL-6, IL-8, and TNF-alpha in febrile children with cancer and neutropenia. Med Oncol. 2001;18:51–57.
Kocak U, Rolston KV, Mullen CA. Fever and neutropenia in children with solid tumors is similar in severity and outcome to that in children with leukemia. Support Care Cancer. 2002;10:58–64.
Kuo FC, Wang SM, Shen CF, et al. Bloodstream infections in pediatric patients with acute leukemia: emphasis on gram-negative bacteria infections. J Microbiol Immunol Infect. 2017;50:507–513.
Freifeld AG, Walsh TJ, Pizzo PA Pizzo PA, Poplack DG. Infectious complications in the pediatric cancer patient. Principles and Practice of Pediatric Oncology. Philadelphia, PA: Lippincott-Raven; 1997:1069–1114.
Glauser MP, Pizzo PA Glauser MP, Pizzo PA. Infections in patients with hematological malignancies. Management of Infections in Immunocompromised Patients. New York, NY: W.B. Saunders; 2000:141–188.
van der Velden WJ, Herbers AH, Netea MG, et al. Mucosal barrier injury, fever and infection in neutropenic patients with cancer: introducing the paradigm febrile mucositis. Br J Haematol. 2014;167:441–452.
Samet A, Sledzinska A, Krawczyk B, et al. Leukemia and risk of recurrent Escherichia coli bacteremia: genotyping implicates E. coli translocation from the colon to the bloodstream. Eur J Clin Microbiol Infect Dis. 2013;32:1393–1400.
Steinberg JP, Robichaux C, Tejedor SC, et al. Distribution of pathogens in central line-associated bloodstream infections among patients with and without neutropenia following chemotherapy: evidence for a proposed modification to the current surveillance definition. Infect Control Hosp Epidemiol. 2013;34:171–175.
Blijlevens NM, Donnelly JP, De Pauw BE. Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant. 2000;25:1269–1278.
Santolaya ME, Alvarez AM, Aviles CL, et al. Predictors of severe sepsis not clinically apparent during the first twenty-four hours of hospitalization in children with cancer, neutropenia, and fever: a prospective, multicenter trial. Pediatr Infect Dis J. 2008;27:538–543.
El-Maghraby SM, Moneer MM, Ismail MM, et al. The diagnostic value of C-reactive protein, interleukin-8, and monocyte chemotactic protein in risk stratification of febrile neutropenic children with hematologic malignancies. J Pediatr Hematol Oncol. 2007;29:131–136.
Fleischhack G, Kambeck I, Cipic D, et al. Procalcitonin in paediatric cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumour necrosis factor receptor II. Br J Haematol. 2000;111:1093–1102.
Fleischhack G, Cipic D, Juettner J, et al. Procalcitonin—a sensitive inflammation marker of febrile episodes in neutropenic children with cancer. Intensive Care Med. 2000;26(suppl 2):S202–211.
Heney D, Lewis IJ, Evans SW, et al. Interleukin-6 and its relationship to C-reactive protein and fever in children with febrile neutropenia. J Infect Dis. 1992;165:886–890.
Lucking V, Rosthoj S. Prediction of bacteremia in children with febrile episodes during chemotherapy for acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2013;30:131–140.
Hazan G, Ben-Shimol S, Fruchtman Y, et al. Clinical and laboratory parameter dynamics as markers of blood stream infections in pediatric oncology patients with fever and neutropenia. J Pediatr Hematol Oncol. 2014;36:e275–e279.
Srinivasan A, Seifried S, Zhu L, et al. Staphylococcus aureus bacteremia in pediatric patients with cancer. Pediatr Infect Dis J. 2010;29:172–174.
Laub K, Tothpal A, Kovacs E, et al. High prevalence of Staphylococcus aureus nasal carriage among children in Szolnok. Hung Acta Microbiol Imm H. 2018;65:59–72.
Wertheim HF, Melles DC, Vos MC, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005;5:751–762.
Ammann RA, Hirt A, Luthy AR, et al. Predicting bacteremia in children with fever and chemotherapy-induced neutropenia. Pediatr Infect Dis J. 2004;23:61–67.
Santolaya ME, Alvarez AM, Becker A, et al. Prospective, multicenter evaluation of risk factors associated with invasive bacterial infection in children with cancer, neutropenia, and fever. J Clin Oncol. 2001;19:3415–3421.