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Non-fermentative Gram-negative rods bacteremia in children with cancer: a 14-year single-center experience

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Abstract

Purpose

Data on non-fermentative Gram-negative rods (NFGNR) bacteremia in children with malignancies are limited. The aim of this study was to present clinical picture, antimicrobial susceptibility pattern, risk factors for resistance and outcome in NFGNR bacteremia in children with cancer.

Methods

All episodes of NFGNR bacteremia occurring during 2001–2014 in children with cancer in a tertiary-care hospital were retrospectively analyzed. Pseudomonas and Acinetobacter spp. resistant to three or more antibiotic classes and all Stenotrophomonas maltophilia (SM) were defined as multidrug-resistant bacteria (MDR).

Results

A total of 80 children (44 males, 0.8–18 years, median 5 years) developed 107 episodes (116 pathogens) of NFGNR bacteremia; Pseudomonas aeruginosa (PA) (51; 43.9%), Acinetobacter baumannii (AB) (21, 18.1%), SM (18, 15.5%); and others (27, 25.2%). The rate of NFGNR bacteremia in children with certain solid tumors (e.g. sarcoma, 12/134 (9.0%)) was comparable to that of hematological malignancies (52/429 (12.2%). Focal infection and septic shock occurred in 16 (14.9%) and four (3.7%) episodes, respectively. Thirty (25.8%) of 116 NFGNR were MDR. The most significant predictors of bacteremia with MDR PA or AB were severe neutropenia (<100 cells/mm3; OR 7.8, p = 0.002), hospital-acquired (OR 16.9, p < 0.0001) and breakthrough (OR 11.2, p < 0.0001) infection. Infection with MDR bacteria was associated with inappropriate empirical therapy. The 30-day mortality was 3/107 (2.8%), all in neutropenic patients with hematological malignancies.

Conclusions

NFGNR bacteremia can present with nonspecific signs or symptoms. MDR NFGNRs are common and compromise treatment options, but mortality is relatively low. Knowledge of local epidemiology, pattern and risk factors for resistance is important to guide empirical therapy.

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Abbreviations

AB:

Acinetobacter baumannii

ALL:

Acute lymphoblastic leukemia

AML:

Acute myeloid leukemia

ANC:

Absolute neutrophil count

BSI:

Bloodstream infections

CLSI:

Clinical and Laboratory Standard Institute

CML:

Chronic myeloid leukemia

CVC:

Central venous catheter

GNR:

Gram-negative rods

HM:

Hematological malignancies

HSCT:

Hematopoietic stem cell transplantation

JMML:

Juvenile myelomonocyte leukemia

MDR:

Multidrug resistant

NFGNRs:

Non-fermentative GNRs

PA:

Pseudomonas aeruginosa

PICU:

Pediatric intensive care unit

SM:

Stenotrophomonas maltophilia

ST:

Solid tumors

TMP-SMX:

Trimethoprim-sulfamethoxazole

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Acknowledgements

This data was presented as a poster at 38th European group of Blood and Marrow Transplantation (EBMT) 2012, Geneva and at 23rd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2013, Berlin.

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    Authors and Affiliations

    1. Pediatric Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

      D. Averbuch, C. Avaky & D. Engelhard

    2. Pediatric Hematology/Oncology and Bone Marrow Transplantation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

      M. Harit, P. Stepensky, I. Fried, T. Ben-Ami, Y. Peled, H. Troen, M. Weintraub & S. Revel-Vilk

    3. Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

      V. Temper

    4. Division of Clinical Pharmacy, School of Pharmacy, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

      R. Masarwa

    5. Braun School of Public Health and Community Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

      W. Abu Ahmad

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    Correspondence to D. Averbuch.

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    S. Revel-Vilk and D. Engelhard contributed equally.

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    Averbuch, D., Avaky, C., Harit, M. et al. Non-fermentative Gram-negative rods bacteremia in children with cancer: a 14-year single-center experience. Infection 45, 327–334 (2017). https://doi.org/10.1007/s15010-017-0988-1

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