Increasing Antimicrobial Resistance Monitored in Surveillance Analysis of Blood Stream Infections in Febrile Neutropenic Pediatric Oncology Patients

  • El-Mahallawy, Hadir A (Clinical Pathology Department, National Cancer Institute, Cairo University) ;
  • Hassan, Safaa Shawky (Clinical Pathology Department, National Cancer Institute, Cairo University) ;
  • El-Wakil, Mohamed (Clinical Oncology Department, Faculty of Medicine, Beni Suef University) ;
  • Moneer, Manar M (Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University) ;
  • Shalaby, Lobna (Oncology Department, National Cancer Institute, Cairo University)
  • Published : 2015.09.02


Background: Continuous surveillance of pattern of blood stream infection is necessary in febrile neutropenia (FN)especially with the recent escalating trend in the management of pediatric cancer patients towards intensified regimens and with the increase in infections caused by resistant organisms limiting the choice of antibiotics. Aim: To monitor change in pattern of blood stream infections (BSI) in FN pediatric cancer patients. Materials and Methods: Surveillance of FN episodes with positive BSI was prospectively monitored and compared to a previous surveillance in the same pediatric oncology unit. Results: A total of 232 BSI positive episodes were documented in 192 patients during a 6 months period. The results of recent surveillance analysis showed an increase in intensified regimens of chemotherapy, antimicrobial resistance, fungal infections, and prolonged duration of episodes when compared to previous surveillance, with p value sof <0.001, 0.005, 0.021, and <0.001, respectively. There was an apparent decrease in the crude mortality but this was not statistically significant, to 6% in 2011 from 10 % in 2006. Conclusions: The pattern of BSI at our institution is still inclining towards gram positive organisms but is showing a shift towards more antibiotic resistance and fungal infections.


  1. Ascioglu S, Rex JH, de Pauw W, et al (2002). Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis, 34, 7-14.
  2. Averbuch D, Orasch C, Cordonnier C, et al (2013). European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of emerging resistance: summary of the 4th European conference on infections in leukemia. Haematologica, 98, 1826-35.
  3. Averbuch D, Cordonnier C, Livermore DM, et al (2013). Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European conference on infections in leukemia (ECIL-4, 2011). Haematologica, 98, 1836-47.
  4. Clinical and Laboratory Standards Institute (2009). Performance standards for antimicrobial susceptibility testing. Nineteenth informational supplement M100-S19. Wayne, PA: Clinical and Laboratory Standards Institute.
  5. Corrado G, Francesco (2011). Current epidemiology and prevention of infectious complications in cancer patients. Euro Oncol Haematol, 7, 270-7.
  6. El-Mahallawy HA, Sidhom I, El-Din NH, Zamzam M, El-Lamie MM (2005). Clinical and microbiological determinants of serious blood stream infections in Egyptian pediatric cancer patients : a one year study Int J Infect Dis, 9, 43-51
  7. El-Mahallawy HA, El-Wakil M, Moneer MM, Shalaby L (2011). Antibiotic resistance is associated with longer bacteremic episodes and worse outcome in febrile neutropenic children with cancer. Pediatric Blood Cancer, 57, 238-88.
  8. Giamarellou H (2010). Multidrug-resistant gram-negative bacteria: how to treat and for how long. Int J Antimicrob Agents, 36, 50-4.
  9. Gudiol C, Bodro M, Simonetti A, et al (2013). Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Clin Microbiol Infect, 19, 474-9.
  10. Hoffmann-Santos HD, Paula CR, Yamamoto AC, Tadano T, Hahn RC (2013).Six-year trend analysis of nosocomial candidemia and risk factors in two intensive care hospitals in Mato Grosso, Midwest Region of Brazil. Mycopathologia, 176, 409-15.
  11. Livermore DM, Warner M, Mushtaq S (2011). What remains against carbapenem-resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline. Int J Antimicrob Agents, 37, 415-9.
  12. Magiorakos AP, Srinivasan A, Carey RB, et al (2012). Multidrugresistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect, 18, 268-81.
  13. Mar M, Carlota G, Carol G-V, Carmen A, Jordi C (2014). Bloodstream infections in patients with solid tumors: Epidemiology, antibiotic therapy, and outcomes in 528 episodes in a single center. Medicine, 93, 143-9.
  14. Naurois J, Novitzky I, Basso, et al (2010). On behalf of the ESMO Guidelines Working Group. Management of febrile neutropenia: ESMO. Clin Practice GuidelinesAnn Oncol, 21, 252-6.
  15. Paramythiotou, Frantzeska F, Flevari A, Armaganidis A, George DE (2014). Invasive fungal infections in the ICU: how to approach, how to treat. Molecules, 19, 1085-119.
  16. Rodri guez L, Ethier MC, Phillips B, et al (2012). Utility of peripheral blood cultures in patients with cancer and suspected blood stream infections: A systematic review. Support Care Cancer, 20, 3261-7.
  17. Sancho S, Artero A, Zaragoza R, et al (2012). Impact of nosocomial polymicrobial bloodstream infections on the outcome in critically ill patients. Eur J Clin Microbiol Infect Dis, 31, 1791-6.
  18. Samonis G, Vardakas KZ, Maraki S, et al (2013). A prospective study of characteristics and outcomes of bacteremia in patients with solid organ or hematologic malignancies. Support Care Cancer, 21, 2521.
  19. Trecarichi EM, Tumbarello M, Spanu T, et al (2009). Incidence and clinical impact of extended-spectrum-beta-lactamase (ESBL) production and fluoroquinolone resistance in bloodstream infections caused by Escherichia coli in patients with hematological malignancies. J Infect, 58, 299-307.

Cited by

  1. Presepsin as a diagnostic marker of bacterial infections in febrile neutropenic pediatric patients with hematological malignancies vol.108, pp.2, 2018,