Jungrungrueng Thanyathorn, Anugulruengkitt Suvaporn, Lauhasurayotin Supanun, Chiengthong Kanhatai, Poparn Hansamon, Sosothikul Darintr, Techavichit Piti
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Pathog. 2021 Mar 29;2021:6692827. doi: 10.1155/2021/6692827. eCollection 2021.
The study aimed to describe the pattern of causative microorganisms, drug susceptibility, risk factors of antibiotic-resistant bacterial infection, and clinical impact of these organisms on pediatric oncology patients with febrile neutropenia.
A retrospective descriptive study of oncologic patients aged less than 15 years who were diagnosed with febrile neutropenia in King Chulalongkorn Memorial Hospital was conducted between January 2013 to December 2017. Characteristics and clinical outcomes of febrile neutropenia episodes, causative pathogens, and their antibiotic susceptibilities were recorded.
This study included 267 patients with 563 febrile neutropenia episodes. The median (range) age was 5.1 years (1 month-15 years). The most common underlying disease was acute lymphoblastic leukemia (42.7%). Of 563 febrile episodes, there were 192 (34.1%) with microbiologically documented infection. Among these 192 episodes of microbiologically documented infection, there were 214 causative pathogens: 154 bacteria (72%), 32 viruses (15%), 27 fungus (12.6%), and 1 (0.4%). Gram-negative bacteria (48.6%) accounted for most of the causative pathogens. Twenty-three percent of them were multidrug resistant, and 18% were carbapenem resistant. Among Gram-positive bacterial infection which accounted for 23.4% of all specimens, the proportion of MRSA was 20%. The 2-week mortality rate was 3.7%. Drug-resistant Gram-negative bacterial infection caused significant adverse events and mortality compared to nonresistant bacterial infection ( < 0.05).
There is high rate of drug-resistant organism infection in pediatric oncology patients in a tertiary-care center in Thailand. Infection with drug-resistant Gram-negative bacterial infection was associated with significant morbidity and mortality. Continuous surveillance for the pattern of drug-resistant infections is crucial.
本研究旨在描述致病性微生物的模式、药敏情况、耐抗生素细菌感染的危险因素，以及这些微生物对小儿肿瘤发热性中性粒细胞减少症患者的临床影响。
对2013年1月至2017年12月期间在朱拉隆功国王纪念医院诊断为发热性中性粒细胞减少症的15岁以下肿瘤患者进行回顾性描述性研究。记录发热性中性粒细胞减少症发作的特征和临床结局、致病病原体及其药敏情况。
本研究纳入267例患者，共563次发热性中性粒细胞减少症发作。中位（范围）年龄为5.1岁（1个月至15岁）。最常见的基础疾病是急性淋巴细胞白血病（42.7%）。在563次发热发作中，192次（34.1%）有微生物学证实的感染。在这192次微生物学证实的感染发作中，有214种致病病原体：154种细菌（72%）、32种病毒（15%）、27种真菌（12.6%）和1种（0.4%）。革兰阴性菌（48.6%）占致病病原体的大多数。其中23%为多重耐药，18%对碳青霉烯类耐药。在占所有标本23.4%的革兰阳性菌感染中，耐甲氧西林金黄色葡萄球菌（MRSA）的比例为20%。2周死亡率为3.7%。与非耐药细菌感染相比，耐药革兰阴性菌感染导致显著的不良事件和死亡率（P<0.05）。
泰国一家三级医疗中心的小儿肿瘤患者中耐药菌感染率较高。耐药革兰阴性菌感染与显著的发病率和死亡率相关。持续监测耐药感染模式至关重要。
