Bacteremia in children with solid tumors

Objectives: To describe the etiology and resistance patterns of bloodstream infections (BSI) in children with solid tumors (ST) and to identify risk factors for developing BSI with multi-drug resistant (MDR) organisms.

Study design: BSI episodes in ST children (2011-2019) in a tertiary pediatric hematology-oncology unit in Jerusalem, Israel were retrospectively analyzed. Clinical, microbiological characteristics, and resistance patterns were documented; factors associated with MDR BSI and mortality were analyzed.

Results: 165 pathogens were isolated in 79 patients (129 episodes); 58.8% were GNR and 40.0% GPC. The most common pathogens were K. pneumoniae (20.6%), E. coli (15.2%) and coagulase-negative staphylococci (11.5%). The proportion of MDR GNR was 14.4%, while the proportion of MDR GPC was 53.0%. In logistic regression analysis, breakthrough on a penicillin-group antibiotic (odds ratio (OR) 10.69, 95% confidence interval (CI) 1.85-61.80, P-value=0.008) and underlying diagnosis of brain tumor (OR 3.64, 95% CI 1.01-13.05, P-value=0.048) were associated with Gram negative (GN) MDR bacteremia; and relapsed disease (OR 4.34, 95% CI 1.47-12.83, P-value=0.04) and the duration of previous hospitalization (OR 1.036/day, 95% CI 1.008-1.064, P-value=0.031) were associated with Gram positive (GP) MDR. Radiation therapy, shock at presentation and pediatric intensive care unit (PICU) admission were associated with 7-days mortality; and neuroblastoma, relapsed disease, shock and PICU admission with 30-days mortality in the univariate analysis.

Conclusions: Children with ST are at risk for MDR bacteremia. Risk factors associated with MDR infections in this population should be further investigated to help guide treatment decisions.