Non-fermentative Gram-negative Rods Bacteremia in Children with Cancer: a 14-year Single-center Experience

Overview

Journal Infection

Date 2017 Feb 17

PMID 28205160

Citations 14

Authors

D Averbuch

C Avaky

M Harit

P Stepensky

I Fried

T Ben-Ami

V Temper

Y Peled

H Troen

R Masarwa

W Abu Ahmad

M Weintraub

S Revel-Vilk

D Engelhard

Affiliations

Soon will be listed here.

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/mm; 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.

Citing Articles

Increased rate of multidrug-resistant gram-negative bacterial infections in hospitalized immunocompromised pediatric patients.

Khafaja S, Salameh Y, Boutros C, Awad C, Faour K, Tfaily N Front Cell Infect Microbiol. 2025; 14():1382500.

PMID: 39835279 PMC: 11743943. DOI: 10.3389/fcimb.2024.1382500.

Global mapping of antibiotic resistance rates among clinical isolates of Stenotrophomonas maltophilia: a systematic review and meta-analysis.

Bostanghadiri N, Sholeh M, Navidifar T, Dadgar-Zankbar L, Elahi Z, van Belkum A Ann Clin Microbiol Antimicrob. 2024; 23(1):26.

PMID: 38504262 PMC: 10953290. DOI: 10.1186/s12941-024-00685-4.

Case series: Stenotrophomonas maltophilia in pediatric oncology patients.

Sarkar S, Stitzlein L, Rav E, Garcia M, Razvi S, Chang M Cancer Rep (Hoboken). 2024; 7(3):e1982.

PMID: 38419283 PMC: 10913069. DOI: 10.1002/cnr2.1982.

The prevalence of colistin resistance in clinical Stenotrophomonas maltophilia isolates worldwide: a systematic review and meta-analysis.

Delgarm Shams-Abadi A, Mohammadian-Hafshejani A, Paterson D, Arash R, Farsani E, Taji A BMC Microbiol. 2023; 23(1):200.

PMID: 37507660 PMC: 10386657. DOI: 10.1186/s12866-023-02950-6.

Global prevalence and antibiotic resistance in clinical isolates of : a systematic review and meta-analysis.

Banar M, Sattari-Maraji A, Bayatinejad G, Ebrahimi E, Jabalameli L, Beigverdi R Front Med (Lausanne). 2023; 10:1163439.

PMID: 37215718 PMC: 10196134. DOI: 10.3389/fmed.2023.1163439.

References

Martino R, Santamaria A, Munoz L, Pericas R, Altes A, Prats G . Bacteremia by gram-negative bacilli in patients with hematologic malignancies. Comparison of the clinical presentation and outcome of infections by enterobacteria and non-glucose-fermenting gram-negative bacilli. Acta Haematol. 1999; 102(1):7-11. DOI: 10.1159/000040960. View

Chiang M, Kuo S, Chen S, Yang S, Lee Y, Chen T . Clinical characteristics and outcomes of bacteremia due to different genomic species of Acinetobacter baumannii complex in patients with solid tumors. Infection. 2011; 40(1):19-26. DOI: 10.1007/s15010-011-0187-4. View

Haeusler G, Mechinaud F, Daley A, Starr M, Shann F, Connell T . Antibiotic-resistant Gram-negative bacteremia in pediatric oncology patients--risk factors and outcomes. Pediatr Infect Dis J. 2013; 32(7):723-6. DOI: 10.1097/INF.0b013e31828aebc8. View

Caselli D, Cesaro S, Ziino O, Zanazzo G, Manicone R, Livadiotti S . Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation. Haematologica. 2010; 95(9):1612-5. PMC: 2930967. DOI: 10.3324/haematol.2009.020867. View

Bakhshi S, Padmanjali K, Arya L . Infections in childhood acute lymphoblastic leukemia: an analysis of 222 febrile neutropenic episodes. Pediatr Hematol Oncol. 2008; 25(5):385-92. DOI: 10.1080/08880010802106564. View

Cattaneo C, Antoniazzi F, Casari S, Ravizzola G, Gelmi M, Pagani C . P. aeruginosa bloodstream infections among hematological patients: an old or new question?. Ann Hematol. 2012; 91(8):1299-304. DOI: 10.1007/s00277-012-1424-3. View

El-Mahallawy H, El-Wakil M, Moneer M, Shalaby L . Antibiotic resistance is associated with longer bacteremic episodes and worse outcome in febrile neutropenic children with cancer. Pediatr Blood Cancer. 2011; 57(2):283-8. DOI: 10.1002/pbc.22926. View

Averbuch D, Orasch C, Cordonnier C, Livermore D, Mikulska M, Viscoli C . European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica. 2013; 98(12):1826-35. PMC: 3856957. DOI: 10.3324/haematol.2013.091025. View

Mueller E, Walkovich K, Mody R, Gebremariam A, Davis M . Hospital discharges for fever and neutropenia in pediatric cancer patients: United States, 2009. BMC Cancer. 2015; 15:388. PMC: 4494157. DOI: 10.1186/s12885-015-1413-8. View

10.

Dix D, Cellot S, Price V, Gillmeister B, Ethier M, Johnston D . Association between corticosteroids and infection, sepsis, and infectious death in pediatric acute myeloid leukemia (AML): results from the Canadian infections in AML research group. Clin Infect Dis. 2012; 55(12):1608-14. DOI: 10.1093/cid/cis774. View

11.

Rosa R, Goldani L, Dos Santos R . Risk factors for multidrug-resistant bacteremia in hospitalized cancer patients with febrile neutropenia: a cohort study. Am J Infect Control. 2013; 42(1):74-6. DOI: 10.1016/j.ajic.2013.06.025. View

12.

Lehrnbecher T, Phillips R, Alexander S, Alvaro F, Carlesse F, Fisher B . Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Oncol. 2012; 30(35):4427-38. DOI: 10.1200/JCO.2012.42.7161. View

13.

Mikulska M, Viscoli C, Orasch C, Livermore D, Averbuch D, Cordonnier C . Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients. J Infect. 2013; 68(4):321-31. DOI: 10.1016/j.jinf.2013.12.006. View

14.

OConnor D, Bate J, Wade R, Clack R, Dhir S, Hough R . Infection-related mortality in children with acute lymphoblastic leukemia: an analysis of infectious deaths on UKALL2003. Blood. 2014; 124(7):1056-61. DOI: 10.1182/blood-2014-03-560847. View

15.

Ammann R, Laws H, Schrey D, Ehlert K, Moser O, Dilloo D . Bloodstream infection in paediatric cancer centres--leukaemia and relapsed malignancies are independent risk factors. Eur J Pediatr. 2015; 174(5):675-86. DOI: 10.1007/s00431-015-2525-5. View

16.

Haupt R, Romanengo M, Fears T, Viscoli C, Castagnola E . Incidence of septicaemias and invasive mycoses in children undergoing treatment for solid tumours: a 12-year experience at a single Italian institution. Eur J Cancer. 2001; 37(18):2413-9. DOI: 10.1016/s0959-8049(01)00274-x. View

17.

Tada K, Kurosawa S, Hiramoto N, Okinaka K, Ueno N, Asakura Y . Stenotrophomonas maltophilia infection in hematopoietic SCT recipients: high mortality due to pulmonary hemorrhage. Bone Marrow Transplant. 2012; 48(1):74-9. DOI: 10.1038/bmt.2012.87. View

18.

Gudiol C, Bodro M, Simonetti A, Tubau F, Gonzalez-Barca E, Cisnal M . Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Clin Microbiol Infect. 2012; 19(5):474-9. DOI: 10.1111/j.1469-0691.2012.03879.x. View

19.

Bartholomew F, Aftandilian C, Andrews J, Gutierrez K, Luna-Fineman S, Jeng M . Evaluation of febrile, nonneutropenic pediatric oncology patients with central venous catheters who are not given empiric antibiotics. J Pediatr. 2014; 166(1):157-62. DOI: 10.1016/j.jpeds.2014.09.008. View

20.

Styczynski J, Czyzewski K, Wysocki M, Gryniewicz-Kwiatkowska O, Kolodziejczyk-Gietka A, Salamonowicz M . Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study. Clin Microbiol Infect. 2015; 22(2):179.e1-179.e10. DOI: 10.1016/j.cmi.2015.10.017. View