Blood Stream Infections in Children with Malignancies: A Single Center Experience Risk Factors, Microbiological Isolates and Sensitivity Pattern

Aim: To determine risk factors, microbiological isolates and antibiotic sensitivity pattern of blood stream infections of pediatric malignancies.

Study Design: A prospective single center cohort study included Children with malignancies that developed one or more episodes of septicemia during the period of their treatment and follow up.

Place and Duration of Study: We included 46 children who were admitted to the Pediatric oncology Unit of Tanta University Hospitals, Egypt, over the period of six months. The included children had a microbiologically confirmed blood stream infections.

Methodology: Positive blood cultures by BacT/ALERT were sub cultured on MacConkey agar, blood agar, chocolate agar, and sabouraud agar. VITEK 2TM Compact 15 was used for verification of bacterial identification and MIC determination.

Results: Sixty seven blood stream infections were detected in 46 patients. Hematological malignancies (67.4%) and neutropenia (69.7%) were the major risk factors. Gram positive bacteria represented (53.7%) including mainly coagulase negative Staphylococci (38.9%) and Streptococci (30.6%). Methicillin resistance was detected in all S. aureus, 71.4% of Coagulase negative Staphylococci that were sensitive to ciprofloxacin (85.7%, 100%), gentamycin (85.7%, 100%) and clindamycin (71.4%) respectively. Gram negative bacteria represent (46.3%) mainly Klebsiella pneumoniae (38.7%). ESBL in Enterobacteriaceae was (81.3%) with sensitivity to ciprofloxacin, amikacin, piperacillin/ tazobactam and sulbactam/ cefoperazone (100%, 100%, 69.2%, 53.8%) respectively. Carbapenem resistance was detected in one isolate of K. pneumoniae, two P. aeruginosa and two A. baumanii. Intestinal translocation of Klebsiella pneumoniae in (41.7%, 5/12) and P. aeruginosa (40%, 2/5), as well as in the four detected cases of central line blood stream infections.

Conclusion: The application of infection control guidelines and the strict antibiotic policy are mandatory for each institute. Selective digestive decontamination is considered to limit translocation. Carbapenem resistance was alarming and mandating more evaluation of β-lactam/β-lactamase inhibitors in treatment of ESBL Enterobacteriaceae.