Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study / 소아감염

ABSTRACT

PURPOSE: This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy. METHODS: A 5-year retrospective study of pediatric hemato-oncologic patients with bacteremia in Seoul National University Children's Hospital, from 2006 to 2010 was conducted. RESULTS: A total of 246 pathogens were isolated, of which 63.4% (n=156) were gram-negative, bacteria 34.6% (n=85) were gram-positive bacteria, and 2.0% (n=5) were fungi. The most common pathogens were Klebsiella spp. (n=61, 24.8%) followed by Escherichia coli (n=31, 12.6%), coagulase-negative staphylococci (n=23, 9.3%), and Staphylococcus aureus (n=22, 8.9%). Resistance rates of gram-positive bacteria to penicillin, oxacillin, and vancomycin were 85.7%, 65.9%, and 9.5%, respectively. Resistance rates of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin were 37.2%, 17.1%, 6.2%, 32.2%, and 13.7%, respectively. Overall fatality rate was 12.7%. Gram-negative bacteremia was more often associated with shock (48.4% vs. 11.9%, P<0.01) and had higher fatality rate than gram-positive bacteremia (12.1% vs. 3.0%, P=0.03). Neutropenic patients were more often associated with shock than non-neutropenic patients (39.6% vs. 22.0%, P=0.04). CONCLUSION: This study revealed that gram-negative bacteria were still dominant organisms of bloodstream infections in children with hemato-oncologic diseases, and patients with gram-negative bacteremia showed fatal course more frequently than those with gram-positive bacteremia.