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LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 495-496
 

Bloodstream infections in children with febrile neutropenia: Isolates and their antimicrobial susceptibility profile


1 Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication10-Mar-2016

Correspondence Address:
W Rose
Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.178422

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How to cite this article:
Rose W, Veeraraghavan B, George B. Bloodstream infections in children with febrile neutropenia: Isolates and their antimicrobial susceptibility profile. Indian J Cancer 2015;52:495-6

How to cite this URL:
Rose W, Veeraraghavan B, George B. Bloodstream infections in children with febrile neutropenia: Isolates and their antimicrobial susceptibility profile. Indian J Cancer [serial online] 2015 [cited 2019 Dec 11];52:495-6. Available from: http://www.indianjcancer.com/text.asp?2015/52/4/495/178422


Sir,

Bloodstream infections (BSIs) in children with febrile neutropenia are a major source of morbidity and mortality.[1] Guidelines have evolved for the use of empiric broad-spectrum antimicrobial therapy at the onset of fever taking into account the patient's clinical condition, local antimicrobial susceptibility patterns, and antimicrobial toxicity profiles.[2] It is important to know the local antimicrobial susceptibility pattern to make the choice of initial antimicrobial therapy most appropriate.[3] In this letter, we report on the organisms causing BSIs in children admitted in the hematology department with febrile neutropenia, and their antimicrobial susceptibility pattern from a tertiary hospital in South India.

All children <15 years with febrile neutropenia admitted under the hematology department during the period between July 2012 and June 2014 who had a positive blood culture were analyzed. The organisms were identified, and their antimicrobial susceptibility pattern studied. All children who presented with fever had blood samples taken under aseptic precautions. The specimens were inoculated and processed by BacT/ALERT system followed by Gram-staining, subculturing on MacConkey agar and 5% sheep blood agar. Biochemical identification of the pathogens was done by standard procedures and antibiotic susceptibility testing done as per Clinical and Laboratory Standards Institute guidelines.

A total of 975 blood cultures were done during the study period. Of them, there were 156 (16%) positive blood cultures with 82 (8.6%) Gram-negative organisms and 74 (7.6%) Gram-positive organisms. Among the Gram-negative organisms, there were 20 (24%) carbapenem-resistant organisms and 40 (49%) extended spectrum beta-lactamase producing organisms. There were 33% (2/6) vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus 15% (2/13). The details of the various organisms and their antimicrobial susceptibilities are given in the [Table 1] and [Table 2].
Table 1: Gram-negative pathogens and their antimicrobial susceptibility

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Table 2: Gram--positive pathogens and their antimicrobial susceptibility

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There is a high rate of BSIs (16%) among children with febrile neutropenia compared with other pediatric BSIs (4.8%). High rates of drug resistance are also observed as is prevalent in all pediatric BSIs.[4] We had more Gram-negative than Gram-positive pathogens, which is also reported by Prabhash et al., though their most common organism isolated was Pseudomonas aeruginosa compared to coagulase negative Staphylococcus (CONS) in our patients.[5] The high rate of indwelling catheter use among our neutropenic children reflects CONS being the most common pathogen. The main limitation of our data is the absence of clinical correlation with the blood cultures. Despite limitations, we hope this data will help guide empiric antimicrobial therapy in children with febrile neutropenia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Auletta JJ, O'Riordan MA, Nieder ML. Infections in children with cancer: A continued need for the comprehensive physical examination. J Pediatr Hematol Oncol 1999;21:501-8.  Back to cited text no. 1
    
2.
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52:e56-93.  Back to cited text no. 2
    
3.
Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, et al. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: Summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 2013;98:1826-35.  Back to cited text no. 3
    
4.
Rose W, Veeraraghavan B, Pragasam AK, Verghese VP. Antimicrobial susceptibility profile of isolates from pediatric blood stream infections. Indian Pediatr 2014;51:752-3.  Back to cited text no. 4
    
5.
Prabhash K, Medhekar A, Ghadyalpatil N, Noronha V, Biswas S, Kurkure P, et al. Blood stream infections in cancer patients: A single center experience of isolates and sensitivity pattern. Indian J Cancer 2010;47:184-8.  Back to cited text no. 5
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