title: Antibiotic resistance is associated with longer bacteremic episodes and worse outcome in febrile neutropenic children with cancer.
abstract: OBJECTIVE
  With the increasing emergence of multiresistant pathogens, better understanding of these infections is necessary. The aim of the present study was to evaluate the risk factors associated with isolating a multiresistant organism (MRO) from a positive blood culture in pediatric cancer patients with febrile neutropenia (F&N), and to study its impact on clinical course and outcome of febrile episodes.
  
  
  METHODS
  The association between MRO with underlying malignancy, age, disease status, hospitalization during episode, absolute neutrophil count, absolute monocyte count, clinical foci of infection, and pathogens isolated was assessed in bacteremic pediatric cancer patients. The MRO phenotype was defined as diminished susceptibility to ≥3 of the broad spectrum antibody classes.
  
  
  RESULTS
  Among 239 episodes of blood stream infections (BSI), Gram-positive, and Gram-negative organisms were detected in 180 (75%), and 59(25%) episodes, respectively; with 38% of isolates showing multiresistance (n = 92). Significant risk factors (P < 0.05) for MRO were hospitalization, Gram-negative organisms, presence of clinical focus of infection, reduced ANC, prolonged duration of neutropenia, and previous intake of antibiotics. Of the episodes with prolonged duration of fever extending for more than 7 days 62% (64|93) were associated with a multiresistant phenotype, while it accompanied 72% (18|25) of the cases with an unfavorable outcome; P-value <0.001.
  
  
  CONCLUSIONS
  Isolation of MRO is more likely to be associated with a prolonged course and an unfavorable outcome. Continuous multidisciplinary surveillance of BSI is warranted to develop strategies for antimicrobial resistance control.
authors.affiliation: Clinical Pathology Department, National Cancer Institute, Cairo University, Egypt. hadir38@hotmail.com
authors.forename: Hadir A
authors.initials: HA
authors.lastname: El-Mahallawy
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Wakil
authors.forename: Manar M
authors.initials: MM
authors.lastname: Moneer
authors.forename: Lobna
authors.initials: L
authors.lastname: Shalaby
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome