Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer.

Autor:	Sfetsiori AE; Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens., Doganis D; Departments of Oncology., Doudoulakakis A; Microbiology, 'P. & A. Kyriakou' Children's Hospital, Athens, Greece., Spyridis N; Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens., Pourtsidis A; Departments of Oncology., Servitzoglou M; Departments of Oncology., Nikita M; Departments of Oncology., Papachristidou S; Departments of Oncology., Magkou E; Departments of Oncology., Dana H; Departments of Oncology., Lebessi E; Microbiology, 'P. & A. Kyriakou' Children's Hospital, Athens, Greece., Kosmidis H; Departments of Oncology., Baka M; Departments of Oncology., Tsolia M; Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens.
Jazyk:	angličtina
Zdroj:	Journal of pediatric hematology/oncology [J Pediatr Hematol Oncol] 2022 Mar 01; Vol. 44 (2), pp. e368-e373.
DOI:	10.1097/MPH.0000000000002253
Abstrakt:	Background: Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment. Materials and Methods: Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria. Results: Among 224 monomicrobial bacterial BSI episodes, Gram-negative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.7:1) versus boys (Gram-negative/Gram-positive ratio 0.72:1), P=0.002, in patients with previous BSI episodes (1.4:1) versus those without (0.8:1), P=0.042, and in children with hematologic malignancy (1.3:1) versus those who suffered from solid tumors (0.52:1), P=0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P=0.009, neutrophils, P=0.009 and platelets, P=0.002, but with significantly higher C-reactive protein (CRP) levels, P=0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis. Conclusions: Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria. Competing Interests: The authors declare no conflict of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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