| Abstract |
Neutropenic fever (FN) is the most common emergency and a major cause of morbidity - mortality in pediatric oncology patients. The most common causative agents of these cases are microbial infections of the blood. In recent decades, significant progress has been made in tackling FN cases, which is reflected in the observed reduction in mortality. Among other things, the timely and appropriate administration of antibiotic therapy plays a key role. Empirical treatment is based on knowledge of the most common bacteria isolated from patients, as well as knowledge of the spectrum of resistance of these bacteria.
In recent years a change has likely occurred in the prevalence of bacteria isolated from blood cultures of children with FN. In particular, while it is reported that Gram staining positive microbes predominate, there is an increase in the frequency of Gram negative6,27. At the same time, worldwide, there is an increase in the resistance of microorganisms to frequently used antibiotic agents and in the spread of multi-resistant strains and pan-resistant strains69. The changing epidemiology of pathogens causing FN episodes is a cause for concern, as bacteria resistant to antimicrobials are associated with more severe infection and worse outcomes44, because of the potential ineffectiveness of the empiric treatment25. To select the appropriate empirical treatment for FN cases, it is recommended to check the microbiological data of each population, as there is great geographical and temporal variation24,29.
The aim of the study is to assess the spectrum and resistance of microbial agents isolated from blood cultures in children and adolescents with cancer and febrile neutropenia in the geographical region of Crete during the period 01/2012 - 02/2022, the assessment of the outcome of events, as well as finding a possible change with time.
This is a retrospective recording study. The study population consists of patients who were diagnosed and treated at the Department of Pediatric Hematology-Oncology of the University Hospital during the period 01/2012 - 02/2022, with episodes of bacteremia and febrile neutropenia. After data collection, we evaluated the outcome, pathogens identified, and susceptibility to antibiotics. We compared epidemiological trends and patterns of resistance across the study period. In particular, we compared the data of the study sample from 01/2012 to 12/2017, with the data from 01/2018 to 02/2022.
Fifty six microbial isolates from blood cultures from 50 episodes of febrile neutropenia were identified. In all, the cases involved 34 patients. Twelve of the patients had more than 1 FN episode and 6 of the FN cases were multimicrobial infections (identification of two strains from a single episode). A statistically significant predominance of Gram-negative pathogens was found during the study period (76.8% vs. 21.4%). The most common species isolated was Escherichia coli (28.6% of all pathogens). The most common Gram - species were Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa (28.6%, 17.9% and 8.9% of all pathogens respectively). Only one of the identified species belonged to the anaerobic bacteria class (Clostridium perfrigens). The observed increase in the frequency of Gram-, during the study period does not show statistical significance. No statistically significant change in microbial susceptibility to any factor was observed during the study, except for a decrease in Gram- Ciprofloxacin sensitivity. 25% of E.coli strains tested positive for broad-spectrum β-lactamase (ESBL) production and 14% of Gram- showed resistance to the carbapenem antibiotic class.
Of particular interest is the predominance of Gram- bacteria, as it is inconsistent with the prevalence reported so far, as well as the finding of carbapenems resistant / ESBL producing Gram- bacteria. We hope that the findings of the microbiological pattern and of the antibiotic resistance presented in the study will be of clinical usefulness for the management of pediatric cancer patients with FN in Crete.
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Εμπύρετη ουδετεροπενία και μικροβιαιμία σε παιδιά και εφήβους με καρκίνο. Εμπειρία της Κλινικής Αιματολογίας-Ογκολογίας Παίδων του ΠΑΓΝΗ κατά το διάστημα 01/2012–02/2022.
