Pediatr Infect Vaccine.  2017 Aug;24(2):71-78. 10.14776/piv.2017.24.2.71.

Etiology of Bacteremia in Children with Hemato-oncologic Diseases from a Single Center from 2011 to 2015

• Park JY
• Yun KW
• Kang HJ
• Park KD
• Shin HY
• Lee HJ
• Choi EH

• KMID: 2401447
• DOI: http://doi.org/10.14776/piv.2017.24.2.71

Abstract

PURPOSE
The aim of this study was to identify the pathogens of blood stream infection (BSI) in children with hemato-oncologic disorders, to analyze susceptibility patterns of microorganisms to guide empirical antimicrobial therapy, and to compare temporal trends of the pathogen and antimicrobial susceptibility with those of previous studies.
METHODS
We retrospectively analyzed the medical records of children with hemato-oncologic disorders whose blood culture grew pathogens at the Seoul National University Children's Hospital between 2011 and 2015.
RESULTS
A total of 167 patients developed 221 episodes of bacteremia. Among 229 pathogens, gram-negative bacteria (GNB) accounted for 69.0% (64.0% in 2002 to 2005, 63.4% in 2006 to 2010); gram-positive bacteria (GPB) accounted for 28.8% (31.3% in 2002 to 2005, 34.6% in 2006 to 2010); and fungus accounted for 2.2%. Among GNB, Klebsiella species (53.2%, 84/158) and Escherichia coli (19.6%, 31/158) were common. Staphylococcus aureus (48.5%, 32/66) and viridans streptococci (21.2%, 14/66) were frequently isolated among GPB. The susceptibilities of oxacillin and vancomycin in GPB were 54.8% and 96.9% (51.5% and 95.5% in 2002 to 2005; 34.1% and 90.5% in 2006 to 2010), respectively, whereas in GNB, the susceptibilities of cefotaxime, piperacillin/tazobactam, and imipenem were 73.2%, 77.2%, and 92.6% (75.9%, 82.8%, and 93.4% in 2002 to 2005; 62.8%, 82.9%, 93.8% and in 2006 to 2010), respectively. There were no significant differences in the proportion of etiologic agents or the antimicrobial susceptibilities between the current study and that of the previous two studies from 2002 to 2010. Overall fatality rate was 13.1%.
CONCLUSIONS
GNB predominated in BSI among children with hemato-oncologic disorders. The etiology of bacteremia and antimicrobial susceptibility were comparable to those of the previous studies. Thus, piperacillin/tazobactam can be used as the initial empirical antimicrobial agent in febrile neutropenia.

Keyword

Bacteremia; Child; Neoplasms; Korea

MeSH Terms

Bacteremia*
Cefotaxime
Child*
Escherichia coli
Febrile Neutropenia
Fungi
Gram-Negative Bacteria
Gram-Positive Bacteria
Humans
Imipenem
Klebsiella
Korea
Medical Records
Oxacillin
Retrospective Studies
Rivers
Seoul
Staphylococcus aureus
Vancomycin
Viridans Streptococci
Cefotaxime
Imipenem
Oxacillin
Vancomycin

Figure

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  Fig. 1 Proportion of gram-positive, gram-negative bacteria, and fungus isolated from bacteremia, 2002 to 2015 1314).

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  Fig. 2 Antibiotic susceptibilities of gram-positive bacterial isolates from bacteremia, 2002 to 2015.

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  Fig. 3 Antibiotic susceptibilities of gram-negative bacterial isolates from bacteremia, 2002 to 2015.

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