Pediatric Infectious Diseases Unit, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel.
The Dyna & Fala Weinstock Department of Pediatric Hematology Oncology, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel.
Microb Drug Resist. 2022 May;28(5):601-610. doi: 10.1089/mdr.2021.0256. Epub 2022 Mar 31.
This retrospective study aims to describe the etiology and resistance patterns of pathogens causing bacteremia in children with solid tumors in a tertiary pediatric hematology-oncology center in Jerusalem, Israel (2011-2019). Factors associated with multidrug-resistant (MDR) bacteremia and mortality were analyzed. A total of 228 pathogens were isolated in 126 patients; 61.0% were gram-negative rods (GNR) and 38.2% were gram-positive cocci (GPC). The most common pathogens were (19.3%), (17.5%), and coagulase-negative staphylococci (16.2%). The proportion of MDR-GNR was 18.2%, while the proportion of MDR-GPC was 55.2%. In logistic regression analysis, breakthrough bacteremia on a penicillin-group antibiotic (odds ratio [OR] 5.69, [95% confidence interval 1.42-22.76], -value = 0.014) was associated and underlying diagnosis of neuroblastoma was inversely associated (OR 0.17, [0.04-0.81], -value = 0.026) with MDR-GNR bacteremia; while the previous hospitalizations' duration (OR 1.032/day, [1.01-1.06], -value = 0.007) and oncologic treatment intensity (OR 2.19, [1.08-4.45, -value = 0.03) were associated with MDR-GPC bacteremia. Shock, prolonged profound neutropenia, and pediatric intensive care unit (PICU) admission were associated with 7-day mortality; and relapsed disease, oncologic treatment intensity, prolonged profound neutropenia, and PICU admission-with 30-day mortality in the univariate analyses. Empirical antibiotic choice should be based on factors associated with MDR infections in this specific population.
这项回顾性研究旨在描述以色列耶路撒冷一家三级儿科血液肿瘤科中心中实体瘤儿童发生菌血症的病原体病因和耐药模式（2011-2019 年）。分析了与多重耐药（MDR）菌血症和死亡率相关的因素。在 126 名患者中分离出 228 种病原体；61.0%为革兰氏阴性杆菌（GNR），38.2%为革兰氏阳性球菌（GPC）。最常见的病原体为 （19.3%）、 （17.5%）和凝固酶阴性葡萄球菌（16.2%）。MDR-GNR 的比例为 18.2%，而 MDR-GPC 的比例为 55.2%。在逻辑回归分析中，青霉素类抗生素治疗期间发生突破感染的菌血症（比值比 [OR] 5.69，95%置信区间 1.42-22.76，-值 = 0.014）与 MDR-GNR 菌血症相关，而潜在诊断为神经母细胞瘤呈负相关（OR 0.17，0.04-0.81，-值 = 0.026）；而之前住院时间（OR 1.032/天，1.01-1.06，-值 = 0.007）和肿瘤治疗强度（OR 2.19，1.08-4.45，-值 = 0.03）与 MDR-GPC 菌血症相关。休克、延长的严重中性粒细胞减少症和儿科重症监护病房（PICU）入住与 7 天死亡率相关；而疾病复发、肿瘤治疗强度、延长的严重中性粒细胞减少症和 PICU 入住与 30 天死亡率相关。在单变量分析中。在这一特定人群中，经验性抗生素选择应基于与 MDR 感染相关的因素。
