Bacterial etiology and antibiotic resistance pattern of pediatric bloodstream infections: A multicenter based study in Tehran, Iran.

BACKGROUND: Due to the diverse nature of bloodstream infections etiology and to the antibiotic resistance patterns in periodic intervals, rational and accurate use of antibiotics requires an understanding of common causative agents of septicemia and their susceptibility patterns. The present study aimed to determine the bacterial etiology of the neonate and pediatric septicemia, and their antibiotic resistance pattern in Tehran, North of Iran. MATERIAL AND METHODS: This retrospective cross-sectional study was conducted along two years, from October 2014 to November 2016 among children with suspected bloodstream infection. Blood specimens were collected aseptically in BACTECTM blood bottles, and standard microbiological methods were applied for the isolation and identification of the bacteria. Antimicrobial susceptibility tests were performed using the disk diffusion method according to Clinical and Laboratory Standards Institute recommendations. RESULTS: Overall, 433 (21.1%) blood cultures showed a significant bacterial growth. Gram-negative bacteria with a proportion of 55.4% were the predominant isolates. The most frequently isolated Gram-negative bacteria were Pseudomonas spp. (26.8%), followed by Klebsiella spp. (8.8%), and Acinetobacter spp. (7.9%). Ciprofloxacin, amikacin, and piperacillin/tazobactam had the highest antibacterial effect on non-fermenting Gram-negative bacilli. Regarding the recovered Enterobacteriaceae, aminoglycosides and carbapenems showed a promising effect for tested isolates. The prevalence of methicillin-resistant S. aureus and coagulase-negative staphylococci were 52.6%, and 78.6%, respectively. The rate of vancomycin-resistant enterococci was estimated 68.8%. Meanwhile, the overall prevalence of multiple-drug resistant isolates was 83.4. CONCLUSION: Regarding results, Multiple Drug Resistant isolates had a significant role in the occurrence of bloodstream infections. Hopefully, several locally available antibiotics still have promising effects on these isolates.

Comparison of Antimicrobial Sensitivity to Older and Newer Quinolones versus Piperacillin-Tazobactam, Cefepime and Meropenem in Febrile Patients with Cancer in two Referral Pediatric Centers in Tehran, Iran.

BACKGROUND: Infection in pediatric cancer patients has become a concerning problem due to increasing antimicrobial resistance. The goal of this study was to determine the antimicrobial resistance patterns of blood isolates from pediatric oncology patients in Iran to determine if there was significant resistance to quinolones. METHODS: Children with cancer who were admitted with or developed fever during admission to Aliasghar Children's Hospital or Mahak Hospitals July 2009 through June 2011 were eligible for enrollment. Two blood cultures were obtained. Antimicrobial sensitivity test was performed for ciprofloxacin, moxifloxacin, gatifloxacin, meropenem, cefepime, and piperacillin-tazobactam on isolates from children who were bacteremic. RESULTS: Blood cultures were positive for 38 episodes in 169 enrolled children but 9 episodes were excluded as blood cultures were thought to be contaminated, yielding a bacteremia rate of 29/160 (18%). The mean age of children and the stage of malignancy did not differ between those with and without bacteremia. Meropenem was the most likely antibiotic to cover isolates (97%) with cefepime having the lowest coverage rate (21%). Quinolone coverage ranged from 63% to 76%. CONCLUSION: Quinolones may not be suitable for use as empiric therapy in febrile pediatric oncology patients in Iran.