Leibson Tom, Ben-Shimol Shalom, Hazan Guy, Fruchtman Yariv, Kapelushnik Joseph, Greenberg David
Pediatric Infectious Diseases Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev.
Harefuah. 2012 Oct;151(10):592-6, 603-4.
Bacterial infections are a major threat to pediatric oncology patients with fever and neutropenia. Current management consists of empiric broad-spectrum antibiotics and prompt medical evaluation. Local bacterial susceptibility rates were published in 2005, and the local protocol (piperacillin and amikacin) was established as an adequate empiric treatment with -100% efficiency against the common pathogens in our pediatric hemato-oncology ward.
To characterize the spectrum of bacteria isolated from blood cultures at the pediatric hemato-oncology ward between 2008- 2010, and to evaluate the current protocol.
A prospective study, conducted in the pediatric hemato-oncologic ward among hospitalized children (2 months - 18 years) with fever and neutropenia. Blood cultures from peripheral blood and central lines were obtained from all patients at admission. Bacterial resistance to various antimicrobial agents was determined.
During 2008-2010, 195 admissions (105 children) due to fever and neutropenia were recorded. Approximately 30% of all blood cultures were positive for a pathogen with -50% Gram positive bacteria mostly CONS. The most prevalent Gram negative bacteria were acinetobacter and klebsiella spp. Candida species were isolated from 7% of positive cultures. Susceptibility rates for the current empiric antimicrobial regimen were about 90%. CONS bacteremia rate increased from 4% in 2000-2002 to 29% in 2008-2010 (p < 0.01).
The currently applied empiric antimicrobial protocol is an optimal first line regimen, considering the susceptibility of the most common pathogens. Judicious use of carbapenems for gram negative bacteria and glycopeptides or other novel antimicrobial agents in cases of CONS bacteremia is required.
细菌感染对发热且中性粒细胞减少的儿科肿瘤患者构成重大威胁。目前的治疗方法包括经验性使用广谱抗生素以及及时进行医学评估。当地细菌药敏率于2005年公布，当地治疗方案（哌拉西林和丁胺卡那霉素）被确定为一种有效的经验性治疗方法，对我们儿科血液肿瘤病房的常见病原体有效率达100%。
描述2008年至2010年间儿科血液肿瘤病房血培养分离出的细菌谱，并评估当前治疗方案。
在儿科血液肿瘤病房对住院的发热且中性粒细胞减少的儿童（2个月至18岁）进行一项前瞻性研究。所有患者入院时均采集外周血和中心静脉血进行血培养。测定细菌对各种抗菌药物的耐药性。
2008年至2010年间，记录了195例因发热和中性粒细胞减少而入院的病例（105名儿童）。所有血培养中约30%的病原体呈阳性，其中约50%为革兰氏阳性菌，主要是凝固酶阴性葡萄球菌。最常见的革兰氏阴性菌是不动杆菌和克雷伯菌属。7%的阳性培养物中分离出念珠菌属。当前经验性抗菌治疗方案的药敏率约为90%。凝固酶阴性葡萄球菌血症发生率从2000年至2002年的4%增至2008年至2010年的29%（p<0.01）。
考虑到最常见病原体的药敏情况，目前应用的经验性抗菌治疗方案是最佳的一线治疗方案。对于革兰氏阴性菌血症，需要谨慎使用碳青霉烯类药物；对于凝固酶阴性葡萄球菌血症，则需要使用糖肽类或其他新型抗菌药物。
