Infect Chemother.  2016 Sep;48(3):181-189. 10.3947/ic.2016.48.3.181.

Increase in Antibiotic-Resistant Gram-Negative Bacterial Infections in Febrile Neutropenic Children

• Lee JH
• Kim SK
• Kim SK
• Han SB
• Lee JW
• Lee DG
• Chung NG
• Cho B
• Jeong DC
• Kang JH
• Kim HK

• KMID: 2466430
• DOI: http://doi.org/10.3947/ic.2016.48.3.181

Abstract

BACKGROUND
The incidence of bacteremia caused by Gram-negative bacteria has increased recently in febrile neutropenic patients with the increase of antibiotic-resistant Gram-negative bacterial infections. This study aimed to identify the distribution of causative bacteria and the proportion of antibiotic-resistant bacteria in bacteremia diagnosed in febrile neutropenic children.
MATERIALS AND METHODS
The medical records of febrile neutropenic children diagnosed with bacteremia between 2010 and 2014 were retrospectively reviewed. The causative bacteria and proportion of antibiotic-resistant bacteria were investigated and compared yearly during the study period. The clinical impact of antibiotic-resistant bacterial infections was also determined.
RESULTS
A total of 336 bacteremia episodes were identified. During the entire study period, 181 (53.9%) and 155 (46.1%) episodes were caused by Gram-negative and Gram-positive bacteria, respectively. Viridans streptococci (25.9%), Klebsiella spp. (16.7%), and Escherichia coli (16.4%) were the most frequent causative bacteria. The overall distribution of causative bacteria was not significantly different annually. Antibiotic-resistant bacteria were identified in 85 (25.3%) episodes, and the proportion of antibiotic-resistant bacteria was not significantly different annually. Extended-spectrum β-lactamase-producing E. coli and Klebsiella spp. were most common among antibiotic-resistant Gram-negative bacteria, and they accounted for 30.6% (n = 34) of the identified E. coli and K. pneumoniae. Methicillin-resistant coagulase-negative staphylococci were most common among antibiotic-resistant Gram-positive bacteria, and it accounted for 88.5% (n = 23) of the identified coagulase-negative staphylococci. Antibiotic-resistant bacterial infections, especially antibiotic-resistant Gram-negative bacterial infections, caused significantly higher mortality due to bacteremia compared with non-antibiotic-resistant bacterial infections (P <0.001).
CONCLUSION
Recently, Gram-negative bacteria caused more bacteremia cases than Gram-positive bacteria in febrile neutropenic children, and antibiotic-resistant Gram-negative bacterial infections increased. Antibiotic-resistant bacterial infections caused poorer prognosis compared with non-antibiotic-resistant bacterial infections, and therefore, continuous surveillance for changing epidemiology of antibiotic-resistant bacterial infections and their clinical impact is necessary.

Keyword

Fever; Neutropenia; Bacteremia; Antibiotic resistance; Child

MeSH Terms

Bacteremia
Bacteria
Bacterial Infections
Child*
Drug Resistance, Microbial
Epidemiology
Escherichia coli
Fever
Gram-Negative Bacteria
Gram-Negative Bacterial Infections*
Gram-Positive Bacteria
Humans
Incidence
Klebsiella
Medical Records
Methicillin Resistance
Mortality
Neutropenia
Pneumonia
Prognosis
Retrospective Studies
Viridans Streptococci

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