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克罗地亚萨格勒布大学医院中心4年期间儿科肿瘤患者的菌尿症:细菌病原体的临床特征、分布及抗菌药物敏感性

Bacteriuria in Paediatric Oncology Patients: Clinical Features, Distribution and Antimicrobial Susceptibility of Bacterial Pathogens at University Hospital Centre Zagreb, Croatia over a 4-Year Period.

作者信息

Predavec Nina, Perčinić Antonio, Herljević Zoran, Rezo Vranješ Violeta, Pavlović Maja, Šalek Zrinko, Kuliš Tomislav, Bilić Ernest, Mareković Ivana

机构信息

Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.

Division of Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.

出版信息

Antibiotics (Basel). 2024 Jan 25;13(2):118. doi: 10.3390/antibiotics13020118.

Abstract

Bacteriuria in paediatric oncology patients have not been well studied. This retrospective study analysed clinical features, distribution and antimicrobial susceptibility of bacterial pathogens cultured from urine in paediatric oncology patients over a 4-year period (2019-2022). A total of 143 episodes of bacteriuria were documented in 74 patients. Neutropenia was present in 17.5% (25/143), symptoms in 25.9% (37/143) and urinary catheter in 7.0% (10/143) episodes. Symptomatic bacteriuria episodes were statistically significantly more frequent in patients with neutropenia ( = 0.0232). The most common bacterial pathogens were (n = 49; 32.2%), spp. (n = 34; 22.4%), (n = 22; 14.5%) and spp. (n = 21; 13.8%). Extended-spectrum β-lactamases-producing (ESBL) Enterobacterales were found in 11 episodes (11/143; 7.7%) with the highest proportion among isolates (n = 7/34; 20.6%). No carbapenem-resistant Enterobacterales, multidrug-resistant or vancomycin-resistant spp. were found. The most important novelties are demonstrating as one of the prominent bacteriuria pathogens in this patient population, presence of ESBL isolates and carbapenem-resistant later during hospitalization highlights the need for appropriate antimicrobial treatment. However, because of the small number of symptomatic patients, further studies are needed to clarify the importance of including urine culture in the diagnostic process in patients with febrile neutropenia.

摘要

儿科肿瘤患者的菌尿症尚未得到充分研究。这项回顾性研究分析了4年期间(2019 - 2022年)儿科肿瘤患者尿液中培养出的细菌病原体的临床特征、分布及抗菌药物敏感性。74例患者共记录到143次菌尿发作。17.5%(25/143)的发作存在中性粒细胞减少,25.9%(37/143)有症状,7.0%(10/143)的发作使用了导尿管。中性粒细胞减少的患者中,有症状的菌尿发作在统计学上显著更频繁(P = 0.0232)。最常见的细菌病原体是大肠埃希菌(n = 49;32.2%)、肺炎克雷伯菌属(n = 34;22.4%)、肠球菌属(n = 22;14.5%)和葡萄球菌属(n = 21;13.8%)。11次发作(11/143;7.7%)中发现产超广谱β-内酰胺酶(ESBL)的肠杆菌科细菌,在肺炎克雷伯菌属分离株中比例最高(n = 7/34;20.6%)。未发现耐碳青霉烯类肠杆菌科细菌、多重耐药的肠球菌或耐万古霉素的葡萄球菌属。最重要的新发现是证实大肠埃希菌是该患者群体中突出的菌尿病原体之一,ESBL分离株的存在以及住院后期出现耐碳青霉烯类肠杆菌科细菌凸显了进行适当抗菌治疗的必要性。然而,由于有症状患者数量较少,需要进一步研究以阐明在发热性中性粒细胞减少患者的诊断过程中进行尿培养的重要性。

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本文引用的文献

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Incidence and Causative Organisms of Bacteriuria in Children With Cancer: A 9-Year Experience in a Tertiary Pediatric Center.
J Pediatr Hematol Oncol. 2023 Jan 1;45(1):21-24. doi: 10.1097/MPH.0000000000002524. Epub 2022 Aug 9.
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Role of urine studies in asymptomatic febrile neutropenic patients presenting to the emergency department.
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