Title:Clinical Characteristics and Risk Factors for Bloodstream Infections in
Children with Cancer: A Report from a Pediatric Hematology Oncology
Unit
Volume: 21
Issue: 3
Author(s): Athanasios Bangeas, Efthymia Protonotariou, Emmanuel Hatzipantelis, Maria Palabougiouki, Maria Ioannidou, Lemonia Skoura, Assimina Galli-Tsinopoulou and Athanasios Tragiannidis*
Affiliation:
- 2nd Paediatric Department, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
Keywords:
Bacteremia, pediatric, oncology, bloodstream infections, risk factors, leukemia, solid tumors.
Abstract:
Background/Aim: Infections are a major cause of morbidity and mortality in children
with haematologic malignancies and solid tumors as well as those undergoing hematopoietic stem
cell transplantation (HSCT). The purpose of our study was to record the epidemiological characteristics
and outcomes of bacteremias, focusing on pathogens, as well as risk factors and mortality
rates in patients of a pediatric hematology-oncology unit from Northern Greece.
Materials and Methods: A retrospective analysis was conducted, which included all positive blood
cultures from pediatric hematology oncology patients aged from 1 to 16 years old admitted to the
Pediatric and Adolescent Hematology Oncology Unit of AHEPA University Hospital of Thessaloniki
between January 2014 and December 2018. Data were collected from patients’ printed and
electronic medical records.
Results: 73 episodes of bacteremias were identified (41% male and 32% female with a ratio of
1.28:1; median age 6.5 years; 13.7% solid tumor, 72.6% acute lymphoblastic leukemia, 13.7%
acute myeloid leukemia, and 95.8% with an indwelling permanent catheter). 49.3% of the isolates
were Gram-positive bacteria and 50.7% Gram-negative, and the ratio of Gram-negative to Grampositive
was 1.02. Coagulase-negative staphylococci were most frequent (39.7%), followed by E.
coli (17.8%) and Klebsiella pneumoniae (17.8%). Out of all Gram-negatives, 13.5% carbapenemase
producers and 8.1% ESBL-producers were found. In relation to Gram-positive, 79.3%
were identified as methicillin-resistant CoNS. During the study period, 10.9% of indwelling catheters
were removed, and 2.73% of episodes resulted in ICU transfer. The 3-month mortality rate
was 8.2%.
Conclusion: This study demonstrated an almost equal distribution of Gram-positive and Gramnegative
bacteremias in total in this population but with an increase in the isolation of Grampositive
bacteria over the last years, which is consistent with other similar studies in this patient
group. Knowledge of the local epidemiology and bacterial antimicrobial resistance is important to
prevent and timely treat these life-threatening infections in immunocompromised pediatric oncology
patients.
