[Bacteremic episodes in pediatric oncologic patients, especially caused by the Streptococcus viridans group].
BACKGROUND
The management of infectious complications plays a major role in the care for pediatric cancer patients. The majority of infections in the neutropenic patient present as fever of unknown origin without recovering a pathogen from the blood stream. The careful evaluation of bacteremic episodes is essential, since knowledge of the bacterial spectrum expected is crucial for the successful anti-infective treatment.


METHODS
From 1985 to 1995 all bacteremic episodes in pediatric oncology patients at the University Children's Hospital Freiburg were retrospectively analyzed with respect to the pathogens encountered, the antibiotic susceptibility profile and the underlying conditions.


RESULTS
Overall, 113 bacteremic episodes were encountered in pediatric oncology patients, 68 of them in patients with hematological malignancies, and 45 in patients with solid tumors. In both patient groups, gram-positive bacteria were predominant with 72% and 58%, respectively. In patients with hematological malignancies, viridans streptococci were the most frequently isolated pathogens (35%) with a relevant morbidity (29% of patients developed a severe sepsis syndrome and/or ARDS), but were found only in 9% of patients with solid tumors. In 28% of patients with leukemia or lymphoma, gram-negative rods were cultured, in 6% Pseudomonas spec., in 4% Acinetobacter spec., and in 18% enterobacteria. In patients with solid tumors, in 38% gram-negative rods were isolated, 7% Pseudomonas spec., 16% Acinetobacter spec., 16% enterobacteria. In 3 patients, fungemia was observed. The antibiotic susceptibility profile was quite favorable in both, gram-positive and -negative bacteria: none of the gram-positive isolates was resistant to vancomycin, none of the Staphylococcus aureus isolates was resistant to oxacillin. All gram-negative bacteria were fully susceptible to ceftazidime, imipenem and ciprofloxacin.


CONCLUSIONS
Gram-positive bacteria account for 2/3 of all bacteremic episodes in pediatric oncology patients. Streptococcus viridans was the most important pathogen in hematological malignancies accounting for a significant, pathogen-specific morbidity.
Berner
R
R
Universitäts-Kinderklinik Freiburg.
Sauter
S
S
Duffner
U
U
Brandis
M
M
Niemeyer
C M
CM
D000293:Adolescent; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000382:microbiology / Q000401:mortality; D008223:Lymphoma / Q000382:microbiology / Q000401:mortality; D008297:Male; D008826:Microbial Sensitivity Tests; D009369:Neoplasms / Q000382:microbiology* / Q000401:mortality; D009503:Neutropenia / Q000382:microbiology* / Q000401:mortality; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D015996:Survival Rate