title: [Microbiological characteristics of pathogens causing bacteremia among hospitalized pediatric oncology patients with fever and neutropenia].
abstract: BACKGROUND
  Bacterial infections are a major threat to pediatric oncology patients with fever and neutropenia. Current management consists of empiric broad-spectrum antibiotics and prompt medical evaluation. Local bacterial susceptibility rates were published in 2005, and the local protocol (piperacillin and amikacin) was established as an adequate empiric treatment with -100% efficiency against the common pathogens in our pediatric hemato-oncology ward.
  
  
  OBJECTIVE
  To characterize the spectrum of bacteria isolated from blood cultures at the pediatric hemato-oncology ward between 2008- 2010, and to evaluate the current protocol.
  
  
  METHODS
  A prospective study, conducted in the pediatric hemato-oncologic ward among hospitalized children (2 months - 18 years) with fever and neutropenia. Blood cultures from peripheral blood and central lines were obtained from all patients at admission. Bacterial resistance to various antimicrobial agents was determined.
  
  
  RESULTS
  During 2008-2010, 195 admissions (105 children) due to fever and neutropenia were recorded. Approximately 30% of all blood cultures were positive for a pathogen with -50% Gram positive bacteria mostly CONS. The most prevalent Gram negative bacteria were acinetobacter and klebsiella spp. Candida species were isolated from 7% of positive cultures. Susceptibility rates for the current empiric antimicrobial regimen were about 90%. CONS bacteremia rate increased from 4% in 2000-2002 to 29% in 2008-2010 (p < 0.01).
  
  
  CONCLUSIONS
  The currently applied empiric antimicrobial protocol is an optimal first line regimen, considering the susceptibility of the most common pathogens. Judicious use of carbapenems for gram negative bacteria and glycopeptides or other novel antimicrobial agents in cases of CONS bacteremia is required.
authors: Pediatric Infectious Diseases Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev.
authors: Tom
authors: T
authors: Leibson
authors: Shalom
authors: S
authors: Ben-Shimol
authors: Guy
authors: G
authors: Hazan
authors: Yariv
authors: Y
authors: Fruchtman
authors: Joseph
authors: J
authors: Kapelushnik
authors: David
authors: D
authors: Greenberg
mesh_terms: D000293:Adolescent; D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016470:Bacteremia / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D002985:Clinical Protocols; D024881:Drug Resistance, Bacterial; D005260:Female; D005334:Fever / Q000209:etiology*; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications / Q000382:microbiology; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D009503:Neutropenia / Q000209:etiology*; D010878:Piperacillin / Q000008:administration & dosage; D015995:Prevalence; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin; D010878:Piperacillin