TOPLINE

Gram-negative bacteria caused nearly 70% of bloodstream infections (BSIs) in pediatric oncology patients over a 12-year period, with Klebsiella species and Escherichia coli being the most common pathogens. The number of isolated pathogens increased from 2012-2017 to 2018-2023, and the frequently used empiric antibiotic therapy (EAT), piperacillin-tazobactam plus amikacin, was found to be appropriate in most pathogens treated with it.

METHODOLOGY

• Researchers conducted a retrospective analysis of bacterial BSI episodes in pediatric oncology patients aged < 18 years at Sheba Medical Center in Ramat Gan, Israel, from 2012 to 2023.
• A total of 456 children experienced 775 bacterial BSI episodes; 63.04% had hematologic malignancies (acute lymphoblastic leukemia and acute myeloid leukemia) and 35.96% had solid tumors (neuroblastoma and central nervous system tumors).
• Median age at BSI episode was 5.51 years; 59.87% of patients had a single BSI episode, 22.15% had 2 episodes, and 10.31% had 3 episodes.
• Neutropenia (absolute neutrophil count of ≤ 500 WBC × 10⁹/L) was present in 57.54% of episodes; fever was documented in 78.71% of cases at the time of culture.
• Outcome measures included pathogen distribution, antimicrobial susceptibility patterns, appropriateness of EAT, and 7-day and 30-day mortality rates.

TAKEAWAY

• Gram-negative bacteria accounted for 68.78% of all pathogens, with Klebsiella species (20.38%), E coli (19.20%), and Pseudomonas aeruginosa (12.10%) being the most common; gram-positive bacteria comprised 30.86%, led by Streptococcus viridans (9.19%), Enterococcus species (6.36%), and Staphylococcus aureus (6.12%).
• From 2012-2017 to 2018-2023, there was a 13.1% increase in the number of isolated pathogens; a 17.30% increase in gram-negative pathogens (P = .001) and a 29.7% decrease in gram-positive pathogens (P = .001). Between the 2 study periods, nonsusceptibility rates of K pneumoniae to ciprofloxacin and to meropenem increased (P = .03 and P = .001, respectively). E coli nonsusceptibility to ciprofloxacin also rose (P = .02).
• The most frequent choices of EAT were piperacillin-tazobactam plus amikacin (28.88% of isolates); it was found appropriate in 90.45% of treatments. The appropriateness of EAT with piperacillin-tazobactam alone was lower (62.61%; P < .0001).
• Seven-day mortality rate was 6.36% and 30-day mortality was 14.69%; deaths within 7 days were commonly associated with K pneumoniae, P aeruginosa, and Enterococcus species.

IN PRACTICE

"For clinically unstable patients, even when at low risk of infection with resistant pathogens, patients with septic shock, those with previous bacterial BSIs or previously colonized with multidrug-resistant pathogens or as a second line of therapy after failure of first-line therapies, we recommended the use of an empiric treatment with piperacillin/tazobactam, meropenem, or meropenem plus amikacin, with the possible addition of vancomycin," the authors of the study wrote.

SOURCE

The study was led by Menucha Jurkowicz, Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center in Ramat Gan, Israel. It was published online on August 12 in European Journal of Pediatrics.

LIMITATIONS

The single-center design limited the generalizability of the findings. The retrospective nature may have resulted in incomplete capture of clinical, laboratory, and treatment characteristics, potentially introducing bias in some cases.

DISCLOSURES

Open access funding was provided by Tel Aviv University. The authors reported no relevant competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.