Clinical Characteristics, Management, and Outcomes in Bacteremia in Immunocompromised Pediatric Patients: A Global Retrospective Study
Griselda Escobedo-Melendez, Parthasarathi Bhattacharyya, Joanna Acebo, Riyadi Adrizain, Bambang Ardianto, Martha Avilés, Maribel Baquera Arteaga, Arpita Bhattacharyya, Sofia Esposto, Dolores Freire Jijon, Samanmalee Gunasekara, Asher Hancock, Hilda Hernandez, Kim Hoa, Vishnu Kaniyarakkal, Reham Khedr, Yanina Lagala, Jacqueline Levy, Medalit Luna, Alejandra Nava, Dilnasheen Safdar, Genara Santana, Eneida Sánchez Medina, Joe Wardell, Meenakshi Devidas, Cesar Villegas, Sergio Licona, Sheena MukkadaAbstract
Background
Infection results in high morbidity, mortality, treatment interruptions and high resource use in children treated for cancer. Bacteremia is one of the most frequent infections in pediatric oncology patients with febrile neutropenic episodes. Short-course antibiotic therapy may decrease toxicity associated with antibiotic use, decrease resource use, and improve patient quality of life. We conducted a retrospective review of clinical characteristics, management, and outcomes associated with bacteremia in pediatric patients with cancer in fifteen hospitals across the globe to identify opportunities for future interventions.
Methods
Electronic and paper records were studied to include pediatric patients with cancer, less than 18 years old, with blood culture positive for bacterial organism, who had received treatment at one of the participating institutions during the period of time from 1st April 2022 to March 31st, 2023. All data were analyzed by descriptive statistics.
Results
A total of 610 bacteremia episodes in 546 pediatric patients with cancer were included, with median age of 8.2 years, and male sex in 55%. Hematologic malignancy was the most frequent oncologic diagnosis (73%), followed by solid tumor (22%) and central nervous system tumor (5%). Comorbidities were present in 12% of patients, and pre-existing chronic medical conditions were scarce. Patients presented median neutrophil count of 230 cell/mm3, and severe and profound neutropenia were found in 25% and 37% of episodes, respectively. With respect to organisms isolated, Gram-negative bacteria were the most frequent {Including E. coli (22%), Pseudomona (21%), Klebsiella (18%) and Acinetobacter (10%)}, followed by Gram-positive bacteria {Including Staphylococcus epidermidids (5.2%), Staphylococcus aureus (4.1%), Staphylococcus Hominis (3.7%), and Streptococcus mitis (2.0%)}. The median antibiotic therapy duration was 6 days {>11 days (38%), 8-10 days (33%), and <7 days (39%)}. Patients required removal of central venous catheter in 30% of episodes, and they were removed due to central line infection in 55%. The isolated organism was susceptible to empiric therapy in 59% of the bacteremia episodes, and meropenem (29%), amikacin (27%), piperacillin/tazobactam (15%) and vancomycin (14%) were the most common antibiotic used. Median length of stay in ICU of 5 days and in hospital of 15 days were documented. A total of 81 deaths (13.4%) were attributed to bacteremia in these patients.
Conclusion
In pediatric oncology patients, bacteremia can cause significant morbidity and mortality, even in those without neutropenia. Future analyses will aim to determine whether specific patient subpopulations and implicated organisms might warrant a trial of shorter therapy.