The Microbiologic Pattern in Pediatric Cancer Patients with Febrile Neutropenia and Bacteremia: A Referral Hospital-Based Study in Northwest of Iran

Background: Neutropenia is a side effect of chemotherapy in children with cancer, among which, bacteremia is the most commonly documented infection. Microbiological pattern of organisms causing bacteremia differs from one medical center to another. Due to the lack of comprehensive studies in Iran on bacteremia and resistance pattern of involved bacteria in febrile neutropenic children with malignancy, this study intended to investigate bacterial factors, and their antibiotic susceptibility and resistance patterns in these children. Methods: In a retrospective study in the Children's hospital of Tabriz from October 2007 to October 2013, medical records of 96 children hospitalized for malignancy with febrile neutropenia and positive blood culture, were reviewed on account of isolated bacteria, and their antimicrobial susceptibility or resistance. Results: The mean age of the patients was 4.96 +/- 3.08 years, and 52.1% (50 children) of them were female. The majority of malignant cases were hematologic with a prevalence of 60.4%, consisting of 35.4% Acute Lymphoblastic Leukemia (ALL), 15.6% Acute Myeloid Leukemia (AML), and 10.4% neuroblastoma. Among the isolated organisms from blood culture, 67.7% and 32.3% were Gram-positive and Gram-negative bacteria, respectively. Coagulase-negative staphylococci (28.1%), Staphylococcus aureus (24%), and Klebsiella pneumoniae (9.4%) were the most common isolated organisms. The rate of antibiotic susceptibility for Gram-negative organisms to ampicillin, gentamicin, ceftriaxone, ceftazidime, amikacin, imipenem, and ciprofloxacin were 61.5%, 66.7%, 37.9%, 16%, 61.5%, 85.2%, and 93.3%, respectively. In addition, 88% of coagulase-negative staphylococci and 77.3% of S. aureus isolates were oxacillin resistant. All cases of S. pneumoniae and Viridans streptococcus, and 50% of non-group A, B or D streptococci were penicillin resistant. Conclusions: The maximum bacterial resistance was observed against older antibiotics. High rate of antibiotic resistance in most organisms, especially coagulase-negative staphylococci and Staphylococcus aureus, is a serious warning to promote the proper use of new antibiotics in empiric and prophylactic therapies.