Original Article

Supportive Care in Cancer

, Volume 21, Issue 9, pp 2417-2426

First online:

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

  • Karin G. E. MiedemaAffiliated withDepartment of Pediatric Oncology/Hematology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen
  • , Rik H. L. J. WinterAffiliated withDepartment of Medical Microbiology, University Medical Center Groningen
  • , Roland A. AmmannAffiliated withDepartment of Pediatrics, University of Bern
  • , Sara DrozAffiliated withInstitute for Infectious Diseases, University of Bern
  • , Lodewijk SpanjaardAffiliated withDepartment of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam
  • , Eveline S. J. M. de BontAffiliated withDepartment of Pediatric Oncology/Hematology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen
  • , Willem A. KampsAffiliated withDepartment of Pediatric Oncology/Hematology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen
  • , Marianne D. van de WeteringAffiliated withDepartment of Pediatric Oncology/Hematology, Emma Children’s Hospital, Academic Medical Center of the University of Amsterdam
  • , Wim J. E. TissingAffiliated withDepartment of Pediatric Oncology/Hematology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen Email author 

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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.

Keywords

Children Cancer Febrile neutropenia Bacteremia Susceptibility