Zajac-Spychala Olga, Wachowiak Jacek, Gryniewicz-Kwiatkowska Olga, Gietka Aneta, Dembowska-Baginska Bozenna, Semczuk Katarzyna, Dzierzanowska-Fangrat Katarzyna, Czyzewski Krzysztof, Dziedzic Magdalena, Wysocki Mariusz, Zalas-Wiecek Patrycja, Szmydki-Baran Anna, Hutnik Lukasz, Matysiak Michal, Pierlejewski Filip, Mlynarski Wojciech, Małas Zofia, Badowska Wanda, Irga-Jaworska Ninela, Bien Ewa, Drozynska Elzbieta, Bartnik Magdalena, Ociepa Tomasz, Urasiński Tomasz, Wawrykow Pawel, Peregud-Pogorzelski Jaroslaw, Stolpa Weronika, Sobol-Milejska Grazyna, Fraczkiewicz Jowita, Salamonowicz Malgorzata, Kazanowska Bernarda, Chybicka Alicja, Chelmecka-Wiktorczyk Liliana, Balwierz Walentyna, Zak Iwona, Gamrot-Pyka Zuzanna, Woszczyk Mariola, Tomaszewska Renata, Szczepanski Tomasz, Plonowski Marcin, Krawczuk-Rybak Maryna, Urbanek-Dadela Agnieszka, Karolczyk Grazyna, Musial Jakub, Chaber Radoslaw, Kowalczyk Jerzy, Styczynski Jan
Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland.
Department of Oncology and Children's Memorial Health Institute, Warszawa, Poland.
Microb Drug Resist. 2021 Jan;27(1):53-63. doi: 10.1089/mdr.2019.0393. Epub 2020 May 20.
Infectious complications (IC) caused by bacterial strains often impede anticancer therapy. The study aimed to retrospectively analyze bacterial IC that could help predict the risk and optimize the empirical treatment for bacterial infections in pediatric cancer patients. Over a 72-month period, all-in 5,599 children with cancer: 2,441 patients with hematological malignancy (HM including acute leukemias, Hodgkin and non-Hodgkin lymphomas [NHLs], and Langerhans cell histiocytosis) and 3,158 with solid tumors (STs including central nervous system tumors, neuroblastoma, Wilms' tumor, soft tissue sarcoma, germ cell tumors, Ewing sarcoma, osteosarcoma, hepatoblastoma, and others) were enrolled into the study. Episodes of bacterial infectious complications (EBICs) confirmed by microbiological findings were reported by each hospital and analyzed centrally. At least 1 EBIC was diagnosed in 2,155 (36.8%) children (1,281 [59.4%] with HM and 874 [40.6%] with ST; < 0.001). All-in 4,860 EBICs were diagnosed including 62.2% episodes in children with HM and 37.8% in children with ST ( < 0.001). Having analyzed the source of infections, blood stream infections predominated, apart from NHL patients in whom the most common type was gut infections. The profile of bacteria strains was different in HM and ST groups ( < 0.001). However, in both groups the most common Gram-negative pathogen was Enterobacteriaceae, with the rate being higher in the HM group. Among Gram-negative strains low susceptibility to ceftazidime, whereas among spp. low susceptibility to vancomycin was noticed. The rate of multidrug-resistant (MDR) pathogens was high, especially for Gram negatives (47.7% vs. 23.9%; < 0.001). The survival after infections was comparable for HM and ST patients ( = 0.215). The risk of bacterial IC in HM patients was higher than in the ST group. The high rate of MDR strains was detected in pediatric cancer patients, especially in those with HM.
由细菌菌株引起的感染性并发症（IC）常常妨碍抗癌治疗。本研究旨在回顾性分析细菌性IC，以帮助预测小儿癌症患者细菌感染的风险并优化经验性治疗。在72个月的时间里，共纳入5599名癌症患儿：2441名血液系统恶性肿瘤（HM，包括急性白血病、霍奇金淋巴瘤和非霍奇金淋巴瘤[NHL]以及朗格汉斯细胞组织细胞增多症）患者和3158名实体瘤（ST，包括中枢神经系统肿瘤、神经母细胞瘤、肾母细胞瘤、软组织肉瘤、生殖细胞肿瘤、尤因肉瘤、骨肉瘤、肝母细胞瘤等）患者。各医院报告经微生物学检查确诊的细菌性感染并发症（EBIC）发作情况，并进行集中分析。2155名（36.8%）儿童至少被诊断出1次EBIC（1281名[59.4%]为HM患者，874名[40.6%]为ST患者；P<0.001）。共诊断出4860次EBIC，其中HM患儿占62.2%，ST患儿占37.8%（P<0.001）。分析感染源后发现，除NHL患者中最常见的感染类型是肠道感染外，血流感染占主导。HM组和ST组的细菌菌株谱不同（P<0.001）。然而，在两组中最常见的革兰氏阴性病原体都是肠杆菌科，在HM组中的发生率更高。在革兰氏阴性菌株中，对头孢他啶的敏感性较低，而在葡萄球菌属中，对万古霉素的敏感性较低。多重耐药（MDR）病原体的发生率很高，尤其是革兰氏阴性菌（47.7%对23.9%；P<0.001）。HM患者和ST患者感染后的生存率相当（P=0.215）。HM患者发生细菌性IC的风险高于ST组。在小儿癌症患者中检测到高比例的MDR菌株，尤其是在HM患者中。
