Skip to main content

Advertisement

SpringerLink
Log in

Bacteria causing bacteremia in pediatric cancer patients presenting with febrile neutropenia—species distribution and susceptibility patterns

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Infections are a major cause of morbidity and mortality in pediatric cancer patients. The aim of this study was to establish the microbiological spectrum and the susceptibility patterns of bacteremia-causing bacteria in pediatric cancer patients with febrile neutropenia in relation to the use of prophylactic and empirical antibiotics.

Methods

We analyzed positive blood cultures of pediatric cancer patients presenting with febrile neutropenia between 2004 and 2011 in Groningen and Amsterdam (the Netherlands) and in Bern (Switzerland), using different antibiotic prophylactic and empirical regimens.

Results

A total of 156 patients with 202 bacteremias, due to 248 bacteria species, were enrolled. The majority (73 %) of bacteremias were caused by Gram-positive bacteria. Gram-negative bacteria, especially Pseudomonas aeruginosa, were observed significantly more often in Bern, where no fluoroquinolone prophylaxis was used. Ciprofloxacin-resistant bacteria were cultured more often from patients who did receive ciprofloxacin prophylaxis, compared to the patients who did not (57 versus 11 %, p = 0.044).

Conclusions

Gram-positive bacteria predominated in this study. We showed that the use of prophylactic antibiotics in pediatric cancer patients was associated with increased resistance rates, which needs further study. The strategy for empiric antimicrobial therapy for febrile neutropenia should be adapted to local antibiotic resistance patterns.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Katz JA, Mustafa MM (1993) Management of fever in granulocytopenic children with cancer. Pediatr Infect Dis J 12(4):330–337

    Article  CAS  Google Scholar 

  2. Bodey GP, Rodriguez V, Chang HY, Narboni (1978) Fever and infection in leukemic patients: a study of 494 consecutive patients. Cancer 41(4):1610–1622

    Article  CAS  Google Scholar 

  3. Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi MS, Martinelli G et al (2005) Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 353(10):977–987

    Article  CAS  Google Scholar 

  4. Kurt B, Flynn P, Shenep JL, Pounds S, Lensing S, Ribeiro RC et al (2008) Prophylactic antibiotics reduce morbidity due to septicemia during intensive treatment for pediatric acute myeloid leukemia. Cancer 113(2):376–382

    Article  Google Scholar 

  5. Gafter-Gvili A, Fraser A, Paul M, Vidal L, Lawrie TA, van de Wetering MD, et al. (2012) Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev (4):CD004386

  6. Zinner SH (1999) Changing epidemiology of infections in patients with neutropenia and cancer: emphasis on gram-positive and resistant bacteria. Clin Infect Dis 29(3):490–494

    Article  CAS  Google Scholar 

  7. Hann I, Viscoli C, Paesmans M, Gaya H, Glauser M, International Antimicrobial Therapy Cooperative Group (IATCG) of the European Organization for Research and Treatment of Cancer (EORTC) (1997) A comparison of outcome from febrile neutropenic episodes in children compared with adults: results from four EORTC studies. Br J Haematol 99(3):580–588

    Article  CAS  Google Scholar 

  8. Paulus S, Dobson S, Rassekh S, Blondel-Hill E (2009) In vitro inferiority of ceftazidime compared with other beta-lactams for viridans group Streptococcus bacteremia in pediatric oncology patients: implications for antibiotic choices. J Pediatr Hematol Oncol 31(4):267–269

    Article  CAS  Google Scholar 

  9. Greenberg D, Moser A, Yagupsky P, Peled N, Hofman Y, Kapelushnik J et al (2005) Microbiological spectrum and susceptibility patterns of pathogens causing bacteraemia in paediatric febrile neutropenic oncology patients: comparison between two consecutive time periods with use of different antibiotic treatment protocols. Int J Antimicrob Agents 25(6):469–473

    Article  CAS  Google Scholar 

  10. El-Mahallawy HA, El-Wakil M, Moneer MM, Shalaby L (2011) Antibiotic resistance is associated with longer bacteremic episodes and worse outcome in febrile neutropenic children with cancer. Pediatr Blood Cancer 57(2):283–288

    Article  Google Scholar 

  11. Caselli D, Cesaro S, Ziino O, Zanazzo G, Manicone R, Livadiotti S et al (2010) Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation. Haematologica 95(9):1612–1615

    Article  CAS  Google Scholar 

  12. Howard DH, Scott RD 2nd, Packard R, Jones D (2003) The global impact of drug resistance. Clin Infect Dis 35(Suppl 1):S4–S10

    Article  Google Scholar 

  13. Agyeman P, Aebi C, Hirt A, Niggli FK, Nadal D, Simon A et al (2011) Predicting bacteremia in children with cancer and fever in chemotherapy-induced neutropenia: results of the prospective multicenter SPOG 2003 FN study. Pediatr Infect Dis J 30(7):e114–e119

    Article  Google Scholar 

  14. Nethmap (2011) Available at: http://www.swab.nl/swab/cms3.nsf/uploads/35ACD3A546C31716C12578BF002EDC4F/$FILE/NethMap2011.pdf. Accessed 20 Jan 2012

  15. Castagnola E, Haupt R, Micozzi A, Caviglia I, Testi AM, Giona F et al (2005) Differences in the proportions of fluoroquinolone-resistant Gram-negative bacteria isolated from bacteraemic children with cancer in two Italian centres. Clin Microbiol Infect 11(6):505–507

    Article  CAS  Google Scholar 

  16. Abe M, Kamijo T, Matsuzawa S, Miki J, Nakazawa Y, Sakashita K et al (2009) High incidence of meropenem resistance among alpha-hemolytic streptococci in children with cancer. Pediatr Int 51(1):103–106

    Article  Google Scholar 

  17. Patterson JE, Hardin TC, Kelly CA, Garcia RC, Jorgensen JH (2000) Association of antibiotic utilization measures and control of multiple-drug resistance in Klebsiella pneumoniae. Infect Control Hosp Epidemiol 21(7):455–458

    Article  CAS  Google Scholar 

  18. Rangaraj G, Granwehr BP, Jiang Y, Hachem R, Raad I (2010) Perils of quinolone exposure in cancer patients: breakthrough bacteremia with multidrug-resistant organisms. Cancer 116(4):967–973

    Article  Google Scholar 

  19. Kennedy HF, Morrison D, Kaufmann ME, Jackson MS, Bagg J, Gibson BE et al (2000) Origins of Staphylococcus epidermidis and Streptococcus oralis causing bacteraemia in a bone marrow transplant patient. J Med Microbiol 49(4):367–370

    Article  CAS  Google Scholar 

  20. Murono K, Hirano Y, Koyano S, Ito K, Fujieda K (2003) Molecular comparison of bacterial isolates from blood with strains colonizing pharynx and intestine in immunocompromised patients with sepsis. J Med Microbiol 52(Pt 6):527–530

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Daria G. Valerio, Danique van Vliet, Sorina Kramps, Martina Raphael, and Patrizia Minz for collecting parts of the data. The work of KGE Miedema was supported by the Dutch ODAS foundation

Conflict of Interest

None declared

Author information

Authors and Affiliations

  1. Department of Pediatric Oncology/Hematology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Karin G. E. Miedema, Eveline S. J. M. de Bont, Willem A. Kamps & Wim J. E. Tissing

  2. Department of Medical Microbiology, University Medical Center Groningen, Groningen, the Netherlands

    Rik H. L. J. Winter

  3. Department of Pediatrics, University of Bern, Bern, Switzerland

    Roland A. Ammann

  4. Institute for Infectious Diseases, University of Bern, Bern, Switzerland

    Sara Droz

  5. Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands

    Lodewijk Spanjaard

  6. Department of Pediatric Oncology/Hematology, Emma Children’s Hospital, Academic Medical Center of the University of Amsterdam, Amsterdam, the Netherlands

    Marianne D. van de Wetering

Authors
  1. Karin G. E. Miedema
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rik H. L. J. Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roland A. Ammann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sara Droz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lodewijk Spanjaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eveline S. J. M. de Bont
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Willem A. Kamps
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marianne D. van de Wetering
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wim J. E. Tissing
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wim J. E. Tissing.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miedema, K.G.E., Winter, R.H.L.J., Ammann, R.A. et al. Bacteria causing bacteremia in pediatric cancer patients presenting with febrile neutropenia—species distribution and susceptibility patterns. Support Care Cancer 21, 2417–2426 (2013). https://doi.org/10.1007/s00520-013-1797-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1797-4

Keywords

Search

Navigation