Update on Healthcare-Associated Blood Stream Infections in Febrile Neutropenic Pediatric Oncology Patients
Author(s)
Hadir A. El-Mahallawy1*,
Safaa Shawky Hassan1,
Mohamed El-Wakil2,
Manar M. Moneer3,
Lobna Shalaby4
Affiliation(s)
1 Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt. 2 Clinical Oncology Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt. 3 Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt. 4 Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
1 Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt. 2 Clinical Oncology Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt. 3 Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt. 4 Pediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
ABSTRACT
Background: Continuous surveillance of pattern of blood stream infection is necessary in febrile neutropenia especially with the recent escalating trend in the management of pediatric cancer patients towards intensified regimens and with the increase in infections caused by resistant organisms limiting the choice of antibiotics. Aim: Monitoring if a change has occurred in pattern of blood stream infections (BSI) in febrile neutropenic (FN) pediatric cancer patients. Methods: Surveillance of FN episodes with positive BSI was prospectively monitored and compared to a previous surveillance in the same pediatric oncology unit. Results: A total of 232 BSI positive episodes were documented in 192 patients during a 6 months period. The results of recent surveillance analysis showed an increase in intensified regimens of chemotherapy, antimicrobial resistance, and prolonged duration of episodes when compared to previous surveillance, with a p value of <0.001, 0.005, and <0.001, respectively. There was an apparent decrease in the crude mortality but this was not statistically significant, 6% in 2011 and 10% in 2006. Conclusion: The pattern of BSI at our institution is still inclining towards gram positive organisms but is showing a shift towards more antibiotic resistance and prolonged episodes.
Background: Continuous surveillance of pattern of blood stream infection is necessary in febrile neutropenia especially with the recent escalating trend in the management of pediatric cancer patients towards intensified regimens and with the increase in infections caused by resistant organisms limiting the choice of antibiotics. Aim: Monitoring if a change has occurred in pattern of blood stream infections (BSI) in febrile neutropenic (FN) pediatric cancer patients. Methods: Surveillance of FN episodes with positive BSI was prospectively monitored and compared to a previous surveillance in the same pediatric oncology unit. Results: A total of 232 BSI positive episodes were documented in 192 patients during a 6 months period. The results of recent surveillance analysis showed an increase in intensified regimens of chemotherapy, antimicrobial resistance, and prolonged duration of episodes when compared to previous surveillance, with a p value of <0.001, 0.005, and <0.001, respectively. There was an apparent decrease in the crude mortality but this was not statistically significant, 6% in 2011 and 10% in 2006. Conclusion: The pattern of BSI at our institution is still inclining towards gram positive organisms but is showing a shift towards more antibiotic resistance and prolonged episodes.
KEYWORDS
Blood Stream Infections (BSI), Febrile Neutropenia (FN), Multidrug Resistant Organism (MDRO)
Blood Stream Infections (BSI), Febrile Neutropenia (FN), Multidrug Resistant Organism (MDRO)
Cite this paper
El-Mahallawy, H. , Hassan, S. , El-Wakil, M. , Moneer, M. and Shalaby, L. (2015) Update on Healthcare-Associated Blood Stream Infections in Febrile Neutropenic Pediatric Oncology Patients. Journal of Cancer Therapy, 6, 504-510. doi: 10.4236/jct.2015.66054.
El-Mahallawy, H. , Hassan, S. , El-Wakil, M. , Moneer, M. and Shalaby, L. (2015) Update on Healthcare-Associated Blood Stream Infections in Febrile Neutropenic Pediatric Oncology Patients. Journal of Cancer Therapy, 6, 504-510. doi: 10.4236/jct.2015.66054.
References
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http://dx.doi.org/10.3324/haematol.2013.091025 [7] El-Mahallawy, H.A., El-Wakil, M., Moneer, M.M. and Shalaby, L. (2011) Antibiotic Resistance Is Associated With Longer Bacteremic Episodes and Worse Outcome in Febrile Neutropenic Children With Cancer. Pediatric Blood & Cancer, 57, 238-288.
http://dx.doi.org/10.1002/pbc.22926 [8] Giamarellou, H. (2010) Multidrug-Resistant Gram-Negative Bacteria: How to Treat and for How Long. International Journal of Antimicrobial Agents, 36, 50-54.
http://dx.doi.org/10.1016/j.ijantimicag.2010.11.014 [9] Naurois, J., Novitzky, I., Basso, G.M.J, Marti, M., Cullen, M.H., Roila, F., et al., On Behalf of the ESMO Guidelines Working Group (2010) Management of Febrile Neutropenia: ESMO Clinical Practice Guidelines. Annals of Oncology, 21, 252-256. [10] Clinical and Laboratory Standards Institute (2009) Performance Standards for Antimicrobial Susceptibility Testing. Nineteenth Informational Supplement M100-S19. Clinical and Laboratory Standards Institute, Wayne. [11] Magiorakos, A.P., Srinivasan, A., Carey, R.B., Carmeli, Y., Falagas, M.E., Giske, C.G., et al. (2012) Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Bacteria: An International Expert Proposal for Interim Standard Definitions for Acquired Resistance. Clinical Microbiology and Infection, 18, 268-281.
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http://dx.doi.org/10.1016/j.ijantimicag.2011.01.012 [17] Averbuch, D., Cordonnier, C., Livermore, D.M., Mikulska, M., Viscoli, C., Orasch, C., et al. (2013) Targeted Therapy against Multi-Resistant Bacteria in Leukemic and Hematopoietic Stem Cell Transplant Recipients: Guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011). Haematologica, 98, 1836-1847.
http://dx.doi.org/10.3324/haematol.2013.091330 [18] Sayed, H., El-Mahallawy, H., Kaddah, A., Ismael, H. and Talaat, S. (2009) Profiles of Infections in Newly Diagnosed Patients with Acute Leukemia during the Induction Phase of Treatment. Journal of the Egyptian National Cancer Institute, 21, 315-322. [19] Simon, A., Ammann, R., Bode, U., Fleischhack, G., Wenchel, H., Schwamborn, D., Gravou, C., et al. (2008) Healthcare-Associated Infections in Pediatric Cancer Patients: Results of a Prospective Surveillance Study from University Hospitals in Germany and Switzerland. BMC Infectious Diseases, 8, 70-75.
http://dx.doi.org/10.1186/1471-2334-8-70
[1] Rodríguez, L., Ethier, M.C., Phillips, B., Lehrnbecher, T., Doyle, J. and Sung, L. (2012) Utility of Peripheral Blood Cultures in Patients with Cancer and Suspected Blood Stream Infections: A Systematic Review. Support Care Cancer, 20, 3261-3267.
http://dx.doi.org/10.1007/s00520-012-1471-2 [2] Sancho, S., Artero, A., Zaragoza, R., Camarena, J.J., González, R. and Nogueira, J.M. (2012) Impact of Nosocomial Polymicrobial Bloodstream Infections on the Outcome in Critically Ill Patients. European Journal of Clinical Microbiology & Infectious Diseases, 31, 1791-1796.
http://dx.doi.org/10.1007/s10096-011-1503-8 [3] Samonis, G., Vardakas, K.Z., Maraki, S., Tansarli, G.S., Dimopoulou, D., Kofteridis, D.P., et al., (2013) A Prospective Study of Characteristics and Outcomes of Bacteremia in Patients with Solid Organ or Hematologic Malignancies. Support Care Cancer, 21, 2521.
http://dx.doi.org/10.1007/s00520-013-1816-5 [4] Trecarichi, E.M., Tumbarello, M., Spanu, T., Caira, M., Fianchi, L., Chiusolo, P., et al. (2009) Incidence and Clinical Impact of Extended-Spectrum-Beta-Lactamase (ESBL) Production and Fluoroquinolone Resistance in Bloodstream Infections Caused by Escherichia coli in Patients with Hematological Malignancies. Journal of Infection, 58, 299-307.
http://dx.doi.org/10.1016/j.jinf.2009.02.002 [5] Girmenia, C. and Menichetti, F. (2011) Current Epidemiology and Prevention of Infectious Complications in Cancer Patients. European Oncology & Haematology, 7, 270-277. [6] Averbuch, D., Orasch, C., Cordonnier, C., Livermore, D.M., Mikulska, M., Viscoli, C., et al. (2013) European Guidelines for Empirical Antibacterial Therapy for Febrile Neutropenic Patients in the Era of Emerging Resistance: Summary of the 4th European Conference on Infections in Leukemia. Haematologica, 98, 1826-1835.
http://dx.doi.org/10.3324/haematol.2013.091025 [7] El-Mahallawy, H.A., El-Wakil, M., Moneer, M.M. and Shalaby, L. (2011) Antibiotic Resistance Is Associated With Longer Bacteremic Episodes and Worse Outcome in Febrile Neutropenic Children With Cancer. Pediatric Blood & Cancer, 57, 238-288.
http://dx.doi.org/10.1002/pbc.22926 [8] Giamarellou, H. (2010) Multidrug-Resistant Gram-Negative Bacteria: How to Treat and for How Long. International Journal of Antimicrobial Agents, 36, 50-54.
http://dx.doi.org/10.1016/j.ijantimicag.2010.11.014 [9] Naurois, J., Novitzky, I., Basso, G.M.J, Marti, M., Cullen, M.H., Roila, F., et al., On Behalf of the ESMO Guidelines Working Group (2010) Management of Febrile Neutropenia: ESMO Clinical Practice Guidelines. Annals of Oncology, 21, 252-256. [10] Clinical and Laboratory Standards Institute (2009) Performance Standards for Antimicrobial Susceptibility Testing. Nineteenth Informational Supplement M100-S19. Clinical and Laboratory Standards Institute, Wayne. [11] Magiorakos, A.P., Srinivasan, A., Carey, R.B., Carmeli, Y., Falagas, M.E., Giske, C.G., et al. (2012) Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Bacteria: An International Expert Proposal for Interim Standard Definitions for Acquired Resistance. Clinical Microbiology and Infection, 18, 268-281.
http://dx.doi.org/10.1111/j.1469-0691.2011.03570.x [12] Freifeld, A., Bow, E., Sepkowitz, K., Boeckh, M., Ito, J., Mullen, C., Raad, I., Young, J. and Wingard, J. (2011) Clinical Practiceguideline for the Use Antimicrobial Agents in Neutropenic Patients with Cance: 2010 Update by the Infectious Disease Society of America. Clinical Infectious Diseases, 52, 56-93.
http://dx.doi.org/10.1093/cid/cir073 [13] El-Mahallawy, H.A., Sidhom, I., El-Din, N.H., Zamzam, M. and El-Lamie, M.M. (2005) Clinical and Microbiological Determinants of Serious Blood Stream Infections in Egyptian Pediatric Cancer Patients: A One Year Study. International Journal of Infectious Diseases, 9, 43-51.
http://dx.doi.org/10.1016/j.ijid.2003.11.010 [14] Gudiol, C., Bodro, M., Simonetti, A., Tubau, F., González-Barca, E., Cisnal, M., et al. (2013) Changing Aetiology, Clinical Features, Antimicrobial Resistance, and Outcomes of Bloodstream Infection in Neutropenic Cancer Patients .Clinical Microbiology and Infection, 19, 474-479.
http://dx.doi.org/10.1111/j.1469-0691.2012.03879.x [15] Mar, M., Carlota, G., Carol, G.-V., Carmen, A. and Jordi, C. (2014) Bloodstream Infections in Patients with Solid Tumors: Epidemiology, Antibiotic Therapy, and Outcomes in 528 Episodes in a Single Center. Medicine, 93, 143-149.
http://dx.doi.org/10.1097/MD.0000000000000026 [16] Livermore, D.M., Warner, M., Mushtaq, S., Doumith, M., Zhang, J. and Woodford, N. (2011) What Remains against Carbapenem-Resistant Enterobacteriaceae? Evaluation of Chloramphenicol, Ciprofloxacin, Colistin, Fosfomycin, Minocycline, Nitrofurantoin, Temocillin and Tigecycline. International Journal of Antimicrobial Agents, 37, 415-419.
http://dx.doi.org/10.1016/j.ijantimicag.2011.01.012 [17] Averbuch, D., Cordonnier, C., Livermore, D.M., Mikulska, M., Viscoli, C., Orasch, C., et al. (2013) Targeted Therapy against Multi-Resistant Bacteria in Leukemic and Hematopoietic Stem Cell Transplant Recipients: Guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011). Haematologica, 98, 1836-1847.
http://dx.doi.org/10.3324/haematol.2013.091330 [18] Sayed, H., El-Mahallawy, H., Kaddah, A., Ismael, H. and Talaat, S. (2009) Profiles of Infections in Newly Diagnosed Patients with Acute Leukemia during the Induction Phase of Treatment. Journal of the Egyptian National Cancer Institute, 21, 315-322. [19] Simon, A., Ammann, R., Bode, U., Fleischhack, G., Wenchel, H., Schwamborn, D., Gravou, C., et al. (2008) Healthcare-Associated Infections in Pediatric Cancer Patients: Results of a Prospective Surveillance Study from University Hospitals in Germany and Switzerland. BMC Infectious Diseases, 8, 70-75.
http://dx.doi.org/10.1186/1471-2334-8-70