Supportive Care in Cancer

, Volume 21, Issue 9, pp 2417–2426 | Cite as

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

  • Karin G. E. Miedema
  • Rik H. L. J. Winter
  • Roland A. Ammann
  • Sara Droz
  • Lodewijk Spanjaard
  • Eveline S. J. M. de Bont
  • Willem A. Kamps
  • Marianne D. van de Wetering
  • Wim J. E. TissingEmail author
Original Article



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.


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.


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).


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.


Children Cancer Febrile neutropenia Bacteremia Susceptibility 



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


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Karin G. E. Miedema
    • 1
  • Rik H. L. J. Winter
    • 2
  • Roland A. Ammann
    • 3
  • Sara Droz
    • 4
  • Lodewijk Spanjaard
    • 5
  • Eveline S. J. M. de Bont
    • 1
  • Willem A. Kamps
    • 1
  • Marianne D. van de Wetering
    • 6
  • Wim J. E. Tissing
    • 1
    Email author
  1. 1.Department of Pediatric Oncology/Hematology, Beatrix Children’s Hospital, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
  2. 2.Department of Medical MicrobiologyUniversity Medical Center GroningenGroningenthe Netherlands
  3. 3.Department of PediatricsUniversity of BernBernSwitzerland
  4. 4.Institute for Infectious DiseasesUniversity of BernBernSwitzerland
  5. 5.Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA)Academic Medical Center of the University of AmsterdamAmsterdamthe Netherlands
  6. 6.Department of Pediatric Oncology/Hematology, Emma Children’s HospitalAcademic Medical Center of the University of AmsterdamAmsterdamthe Netherlands

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