Siddaiahgari Sirisharani, Manikyam A, Kumar K Anand, Rauthan A, Ayyar R
Department of Pediatric Hematology Oncology, Rainbow Childrens Hospital, Banjara Hills, Hyderabad, Telangana, India.
Indian J Cancer. 2014 Oct-Dec;51(4):403-5. doi: 10.4103/0019-509X.175367.
Outcome of pediatric cancers has significantly improved with modern chemotherapy and good supportive care. However, febrile neutropenia remains one of the important limiting factors in these patients especially with the emergence of resistant organisms. Choosing appropriate antimicrobials is possible only if we understand the local microbial spectrum and their sensitivity pattern.
To study the likely etiologic agents and their antibiotic sensitivity pattern among systemic infections in children with cancer.
This is a prospective study.
The study was conducted at a tertiary care center for pediatrics, in which culture samples representing blood stream infections and others like urinary tract infections sent from the Oncology services of the Hospital during the year of 2013 were analyzed. The microbiological profile and antibiotic sensitivity pattern of these isolates were studied.
There were 89 isolates that represented blood and urinary tract infections in neutropenic patients with cancer.Out of 89 positive cultures 76 were gram negative isolates. The most common gram negative bacterial isolates were Escherichia coli 33 (37%), followed by Pseudomonas 21 (23.5%). Acinetobacter grew in 2 patients (2.2%). Extended spectrum beta-lactamases (ESBL's), carbepenem resistant and pan-resistant organisms seen in 28 (31.4%), 5 (5.6%) and 2 cases (2.3%) respectively. Over all Gram-positive organisms were 13/89 (12.3%). Staphylococcus was the most common Gram-positive organism and methicillin resistant Staphylococcus aureus seen in 5 each.
Gram-negative organism is a common isolate in cancer children with febrile neutropenia, which is resistant to first-line antibiotic cefepime. Meropenem is most sensitive antibiotic and ESBL's are sensitive to piperacillin-tazobactam.
随着现代化疗和良好的支持治疗，儿童癌症的治疗效果有了显著改善。然而，发热性中性粒细胞减少症仍然是这些患者的重要限制因素之一，尤其是随着耐药菌的出现。只有了解当地的微生物谱及其敏感性模式，才有可能选择合适的抗菌药物。
研究癌症患儿全身感染中可能的病原体及其抗生素敏感性模式。
这是一项前瞻性研究。
该研究在一家儿科三级护理中心进行，分析了2013年从医院肿瘤服务部门送来的代表血流感染和其他如尿路感染的培养样本。研究了这些分离株的微生物学特征和抗生素敏感性模式。
有89株分离株代表癌症中性粒细胞减少患者的血液和尿路感染。在89份阳性培养物中，76份为革兰氏阴性分离株。最常见的革兰氏阴性细菌分离株是大肠杆菌33株（37%），其次是铜绿假单胞菌21株（23.5%）。不动杆菌在2例患者中生长（2.2%）。分别在28例（31.4%）、5例（5.6%）和2例（2.3%）中发现超广谱β-内酰胺酶（ESBLs）、耐碳青霉烯类和泛耐药菌。总体而言，革兰氏阳性菌为13/89（12.3%）。葡萄球菌是最常见的革兰氏阳性菌，耐甲氧西林金黄色葡萄球菌各有5株。
革兰氏阴性菌是发热性中性粒细胞减少症癌症患儿的常见分离株，对一线抗生素头孢吡肟耐药。美罗培南是最敏感的抗生素，ESBLs对哌拉西林-他唑巴坦敏感。
