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Escobedo-Melendez G, Paniagua-Padilla J, Caniza MA. Outcomes of Care-bundle Implementation for Children With Cancer and Suspected Bloodstream Infection in a Pediatric Oncology Unit in a Resource-limited Setting. J Pediatr Hematol Oncol 2023; 45:e798-e809. [PMID: 37526415 PMCID: PMC10521769 DOI: 10.1097/mph.0000000000002719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/20/2023] [Indexed: 08/02/2023]
Abstract
Bloodstream infections (BSIs) are a major cause of mortality among pediatric oncology patients in resource-limited settings. Effective, innovative strategies are needed to improve care and survival. In a pediatric oncology unit in Mexico, we retrospectively analyzed the risk factors for mortality related to BSI and the results of using a care-bundle intervention. The care-bundle consisted of a swift clinical evaluation, initial fluid-resuscitation support, obtaining blood cultures, and administration of effective empirical antibiotic therapy for suspected BSI. The outcomes of patients who received the care-bundle during a 12-month period were compared with those of patients treated with standard care during the 12 months preceding its implementation. The primary outcomes were BSI diagnosis, choice of antibiotics, and mortality. Of the 261 suspected BSIs treated with standard care, 33 (12.6%) infections were confirmed, and of the 308 treated with the care-bundle, 67 (21.7%) BSIs were confirmed. Thus, after implementation of the care-bundle, significantly more BSIs were diagnosed ( P =0.004), and BSI-related mortality was significantly reduced by 22.2% ( P = 0.035). Surgical resection and mechanical ventilation support were independently associated with BSI-related mortality, and receiving effective initial empirical antibiotic therapy was protective against mortality (odds ratio, 0.013; 95% CI: 0.002-0.105; P =0.001), which comprising cefepime plus amikacin or meropenem in 44 (80.0%) of the cases alive. Consistent use of a care-bundle with initial fluid resuscitation, obtaining a blood culture, and administering effective antibiotics to children with cancer and suspected BSI can decrease mortality.
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Affiliation(s)
- Griselda Escobedo-Melendez
- Institute for Research in Childhood and Adolescence Cancer, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Jenny Paniagua-Padilla
- Institute for Research in Childhood and Adolescence Cancer, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Miguela A. Caniza
- Departments of Global Pediatric Medicine and Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN
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Nasution ES, Muchtar R, Syahputra RA. The Study of Drug-Related Problems in Pediatric Inpatients Utilizing Antibiotics in Universitas Sumatera Utara Hospital Medan, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Drug-related problems (DRPs) and errors occur frequently in general health and pediatric care due to several reasons.
AIM: This study aims to determine the DRPs incidence in pediatric inpatients utilizing antibiotics in Universitas Sumatera Utara Hospital, Medan, Indonesia.
MATERIALS AND METHODS: It was carried out in May–July 2019 using a retrospective cross-sectional method and the data obtained from June to December 2018.
RESULTS: In the aforementioned hospital, the medical records of patients were 575 among which 135 (23.47%) met the inclusion criteria and the males, 84 (62.22%) were higher than females. Furthermore, majority of them, 55 (40.74%) were 5–11 years old, and 86 (63.70%) had a maximum stay length of ≥5 days. There were 73 DRPs events in 37 patients, namely, 46 (63.01%) low doses, 22 (30.14%) overdoses, 2 (2.74%) side effects of drugs, and 3 (4.11%) drug interactions. The most experienced antibiotic DRPs were in cefotaxime 14 (19.17%) and the most diagnosed was in appendicitis 14 (10.37%) utilization.
CONCLUSION: There were antibiotic DRPs in pediatric inpatients in Universitas Sumatera Utara Hospital, Medan.
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The Pattern of Microorganisms and Drug Susceptibility in Pediatric Oncologic Patients with Febrile Neutropenia. J Pathog 2021; 2021:6692827. [PMID: 33854800 PMCID: PMC8021465 DOI: 10.1155/2021/6692827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/18/2021] [Indexed: 11/18/2022] Open
Abstract
Objective The study aimed to describe the pattern of causative microorganisms, drug susceptibility, risk factors of antibiotic-resistant bacterial infection, and clinical impact of these organisms on pediatric oncology patients with febrile neutropenia. Methods A retrospective descriptive study of oncologic patients aged less than 15 years who were diagnosed with febrile neutropenia in King Chulalongkorn Memorial Hospital was conducted between January 2013 to December 2017. Characteristics and clinical outcomes of febrile neutropenia episodes, causative pathogens, and their antibiotic susceptibilities were recorded. Result This study included 267 patients with 563 febrile neutropenia episodes. The median (range) age was 5.1 years (1 month-15 years). The most common underlying disease was acute lymphoblastic leukemia (42.7%). Of 563 febrile episodes, there were 192 (34.1%) with microbiologically documented infection. Among these 192 episodes of microbiologically documented infection, there were 214 causative pathogens: 154 bacteria (72%), 32 viruses (15%), 27 fungus (12.6%), and 1 Mycobacterium tuberculosis (0.4%). Gram-negative bacteria (48.6%) accounted for most of the causative pathogens. Twenty-three percent of them were multidrug resistant, and 18% were carbapenem resistant. Among Gram-positive bacterial infection which accounted for 23.4% of all specimens, the proportion of MRSA was 20%. The 2-week mortality rate was 3.7%. Drug-resistant Gram-negative bacterial infection caused significant adverse events and mortality compared to nonresistant bacterial infection (p < 0.05). Conclusion There is high rate of drug-resistant organism infection in pediatric oncology patients in a tertiary-care center in Thailand. Infection with drug-resistant Gram-negative bacterial infection was associated with significant morbidity and mortality. Continuous surveillance for the pattern of drug-resistant infections is crucial.
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Tural Kara T, Erat T, Yahşi A, Özdemir H, İleri T, İnce E, Taçyıldız N, Ünal E, Çiftçi E, İnce E. Bloodstream infections in pediatric hematology/oncology patients: Six years’ experience of a single center in Turkey. Turk J Med Sci 2019; 49:1157-1164. [PMID: 31342734 PMCID: PMC7018311 DOI: 10.3906/sag-1812-101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/aim Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalization, and mortality in pediatric patients. Identifying the predominant microorganisms and antimicrobial susceptibilities in centers helps to select effective empirical antimicrobials which leads to positive clinical outcomes. We aimed to identify the causative microorganisms and their antimicrobial susceptibilities in patients with bloodstream infections. Materials and methods Data belonging to patients with hematological and/or oncological diseases admitted to our hospital with fever between January 2010 and November 2015 were analyzed. Results In total, 71 patients who had 111 bloodstream infection episodes were included. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria, and 4.4% fungi. The most common causative gram-negative pathogen was Escherichia coli and the most commonly isolated gram-positive microorganism was coagulase-negative staphylococci. Conclusion Gram-negative microorganisms were predominant pathogens in bloodstream infections. Escherichia coli and coagulase-negative staphylococci were the most commonly isolated responsible pathogens. Beta-lactam/lactamase inhibitors were suitable for empirical treatment. However, in critical cases, colistin could have been used for empirical treatment until the culture results were available. Routine glycopeptide use was not required. By identifying the causative microorganisms and their antimicrobial resistance patterns, it will be possible to obtain positive clinical results.
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Affiliation(s)
- Tuğçe Tural Kara
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tuğba Erat
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aysun Yahşi
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Talia İleri
- Department of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif İnce
- Department of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nurdan Taçyıldız
- Department of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Ünal
- Department of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdal İnce
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
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Töret E, Karapınar T, Bulut M, Aksay A, Ay Y, Oymak Y, Devrim İ, İnce D. Kanserli Çocuklarda Febril Nötropeni Ataklarının İncelenmesi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2018. [DOI: 10.17944/mkutfd.489213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kar YD, Özdemir ZC, Bör Ö. Evaluation of febrile neutropenic attacks of pediatric hematology-oncology patients. Turk Arch Pediatr 2017; 52:213-220. [PMID: 29483801 DOI: 10.5152/turkpediatriars.2017.5312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/23/2017] [Indexed: 12/23/2022]
Abstract
Aim Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The objective of this study was to evaluate febrile neutropenic episodes in children with malignancy. Material and Methods Sixty-eight children who received chemotherapy for malignancy between 2010 and 2015 were retrospectively reviewed. The demographic characteristics, laboratory data, infection foci, and frequency of microorganisms grown in culture were examined. Also, the frequency of febrile neutropenic attacks was investigated according to the chemotherapy periods. Results Of the total 200 episodes, 81 (40.5%) were clinically documented, and 73 (36.5%) were microbiologically documented infections. Fever of unknown origin was observed in 46 (23%) episodes. The most frequently clinically documented focus were mucositis (33.4%) and pneumonia (24.7%). Blood culture was positive in 55 (75.3%) episodes of microbiologically documented infections. The most commonly isolated microorganisms in blood culture were Gram-negative bacteria (47.2%). C-reactive protein levels in microbiologically documented infections were higher than in clinically documented infections, and fever of unknown origin (p<0.05, for both). The most common underlying malignancy was acute lymphoblastic leukemia (73.5%). The highest proportions (34.6%) of febrile neutropenic episodes were observed during the reinduction period for these children. Nine (13.2%) children died of neutropenic sepsis. Conclusions Febrile neutropenia continues to be an important cause of mortality in pediatric patients with malignancy. C-reactive protein levels may be an indicator for predicting bacterial infection in children with febrile neutropenia without apparent focus. The most frequently isolated agents in our center were Gram-negative microorganisms. Determining the microbial flora of each center may be beneficial to improving survival rates.
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Affiliation(s)
- Yeter Düzenli Kar
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Eskişehir, Turkey
| | - Zeynep Canan Özdemir
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Eskişehir, Turkey
| | - Özcan Bör
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology-Oncology, Eskişehir, Turkey
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Carlesse F, Cappellano P, Quiles MG, Menezes LC, Petrilli AS, Pignatari AC. Clinical relevance of molecular identification of microorganisms and detection of antimicrobial resistance genes in bloodstream infections of paediatric cancer patients. BMC Infect Dis 2016; 16:462. [PMID: 27585633 PMCID: PMC5007997 DOI: 10.1186/s12879-016-1792-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/21/2016] [Indexed: 12/25/2022] Open
Abstract
Background Bloodstream infections (BSIs) are the major cause of mortality in cancer patients. Molecular techniques are used for rapid diagnosis of BSI, allowing early therapy and improving survival. We aimed to establish whether real-time quantitative polymerase chain reaction (qPCR) could improve early diagnosis and therapy in paediatric cancer patients, and describe the predominant pathogens of BSI and their antimicrobial susceptibility. Methods Blood samples were processed by the BACTEC system and microbial identification and susceptibility tests were performed by the Phoenix system. All samples were screened by multiplex 16 s rDNA qPCR. Seventeen species were evaluated using sex-specific TaqMan probes and resistance genes blaSHV, blaTEM, blaCTX, blaKPC, blaIMP, blaSPM, blaVIM, vanA, vanB and mecA were screened by SYBR Green reactions. Therapeutic efficacy was evaluated at the time of positive blood culture and at final phenotypic identification and antimicrobial susceptibility results. Results We analyzed 69 episodes of BSI from 64 patients. Gram-positive bacteria were identified in 61 % of the samples, Gram-negative bacteria in 32 % and fungi in 7 %. There was 78.2 % of agreement between the phenotypic and molecular methods in final species identification. The mecA gene was detected in 81.4 % of Staphylococcus spp., and 91.6 % were concordant with the phenotypic method. Detection of vanA gene was 100 % concordant. The concordance for Gram-negative susceptibilities was 71.4 % for Enterobacteriaceae and 50 % for Pseudomonas aeruginosa. Therapy was more frequently inadequate in patients who died, and the molecular test was concordant with the phenotypic susceptibility test in 50 %. Conclusions qPCR has potential indication for early identification of pathogens and antimicrobial resistance genes from BSI in paediatric cancer patients and may improve antimicrobial therapy.
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Affiliation(s)
- Fabianne Carlesse
- Institute of Paediatric Oncology, Universidade Federal de São Paulo, Rua Botucatu 743, São Paulo, 04037020, Brazil.
| | - Paola Cappellano
- Infectious Diseases Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Antonio Sérgio Petrilli
- Institute of Paediatric Oncology, Universidade Federal de São Paulo, Rua Botucatu 743, São Paulo, 04037020, Brazil
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Vardakas KZ, Legakis NJ, Triarides N, Falagas ME. Susceptibility of contemporary isolates to fosfomycin: a systematic review of the literature. Int J Antimicrob Agents 2016; 47:269-85. [DOI: 10.1016/j.ijantimicag.2016.02.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/22/2016] [Indexed: 02/01/2023]
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Blennow O, Ljungman P. The challenge of antibiotic resistance in haematology patients. Br J Haematol 2015; 172:497-511. [PMID: 26492511 DOI: 10.1111/bjh.13816] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Bacterial infections were once a major obstacle to the treatment of acute leukaemia. Improvement in management strategies, including the use of broad-spectrum antibacterial drugs targeting Gram-negative bacteria, has reduced the mortality in neutropenic patients developing blood stream infections and other severe infections. In many countries these achievements are threatened by development of multi-resistant bacteria, such as Klebsiella pneumoniae, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. This review addresses the epidemiology, clinical importance and possible management of these multi-resistant organisms.
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Affiliation(s)
- Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Per Ljungman
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Haematology and Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
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Caselli D, Cesaro S, Fagioli F, Carraro F, Ziino O, Zanazzo G, Meazza C, Colombini A, Castagnola E. Incidence of colonization and bloodstream infection with carbapenem-resistant Enterobacteriaceae in children receiving antineoplastic chemotherapy in Italy. Infect Dis (Lond) 2015; 48:152-5. [PMID: 26393496 DOI: 10.3109/23744235.2015.1087647] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Few data are available on the incidence of carbapenemase-producing Enterobacteriaceae (CPE) infection or colonization in children receiving anticancer chemotherapy. We performed a nationwide survey among centers participating in the pediatric hematology-oncology cooperative study group (Associazione Italiana Ematologia Oncologia Pediatrica, AIEOP). During a 2-year observation period, we observed a threefold increase in the colonization rate, and a fourfold increase of bloodstream infection episodes, caused by CPE, with a 90-day mortality of 14%. This first nationwide Italian pediatric survey shows that the circulation of CPE strains in the pediatric hematology-oncology environment is increasing. Given the mortality rate, which is higher than for other bacterial strains, specific monitoring should be applied and the results should have implications for health-care practice in pediatric hematology-oncology.
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Affiliation(s)
- Desiree Caselli
- a Azienda Ospedaliera Universitaria Meyer Children Hospital , Firenze
| | - Simone Cesaro
- b Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata , Verona
| | - Franca Fagioli
- c Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital , Torino
| | - Francesca Carraro
- c Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital , Torino
| | - Ottavio Ziino
- d Pediatric Hematology Oncology, ARNAS Civico , Palermo
| | | | - Cristina Meazza
- f Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori , Milano
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Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer. Curr Opin Infect Dis 2014; 27:200-10. [DOI: 10.1097/qco.0000000000000038] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection 2013; 42:5-13. [PMID: 23975584 DOI: 10.1007/s15010-013-0525-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/13/2013] [Indexed: 01/03/2023]
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Zhou ZY, Zhao XQ, Shan BZ, Zhu J, Zhang X, Tian QF, Chen DF, Jia TH. Efficacy and safety of linezolid in treating gram-positive bacterial infection in the elderly: a retrospective study. Indian J Microbiol 2013; 54:104-7. [PMID: 24426174 DOI: 10.1007/s12088-013-0422-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 07/25/2013] [Indexed: 11/29/2022] Open
Abstract
Linezolid is commonly used for the treatment of drug-resistant Gram-positive bacterial infection. This study aimed to evaluate the efficacy and safety of linezolid in treating Gram-positive bacterial infection in the elderly from January 2010 to December 2012. Total 40 elderly patients (>60 years old) with Gram-positive bacterial infection were treated with linezolid and their demographic and clinical data were collected and analyzed. Among the 40 patients, 31 patients (77.5 %) were cured. Linezolid caused little adverse effects on liver and renal function. The main adverse effect was thrombocytopenia and its incidence was significantly associated with baseline platelet count and the duration of treatment (P < 0.05). Logistic regression analysis showed that the baseline platelet count <200 × 10(6)/mL, but not the age, the sex, the length of hospital stay, baseline levels of hemoglobin, alanine aminotransferase, or creatinine clearance rate was significantly associated with linezolid-induced thrombocytopenia. In conclusion, linezolid is effective to cure Gram-positive bacterial infection in the elderly and causes little adverse effects on liver and renal function. Timely monitoring of baseline platelet count may be helpful to guide the use of linezolid to avoid the occurrence of thrombocytopenia.
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Affiliation(s)
- Zhi-Yong Zhou
- Department of Orthopaedic Surgery, Jinan Central Hospital affiliated to Shandong University, 105# Jiefang Road, Jinan, 250013 Shandong China ; Department of Orthopedics, Yantai Shan Hospital, 91 Jiefang Rd, Yantai, 264000 Shandong China
| | - Xue-Qin Zhao
- Department of Orthopedics, Yantai Shan Hospital, 91 Jiefang Rd, Yantai, 264000 Shandong China
| | - Bao-Zhong Shan
- Department of Orthopaedic Surgery, Jinan Central Hospital affiliated to Shandong University, 105# Jiefang Road, Jinan, 250013 Shandong China
| | - Jie Zhu
- Department of Orthopaedic Surgery, Jinan Central Hospital affiliated to Shandong University, 105# Jiefang Road, Jinan, 250013 Shandong China
| | - Xiang Zhang
- Department of Orthopaedic Surgery, Jinan Central Hospital affiliated to Shandong University, 105# Jiefang Road, Jinan, 250013 Shandong China
| | - Qing-Fen Tian
- Department of Orthopaedic Surgery, Jinan Central Hospital affiliated to Shandong University, 105# Jiefang Road, Jinan, 250013 Shandong China
| | - De-Fang Chen
- Department of Orthopaedic Surgery, Jinan Central Hospital affiliated to Shandong University, 105# Jiefang Road, Jinan, 250013 Shandong China
| | - Tang-Hong Jia
- Department of Orthopaedic Surgery, Jinan Central Hospital affiliated to Shandong University, 105# Jiefang Road, Jinan, 250013 Shandong China
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