title: Bacteria causing bacteremia in pediatric cancer patients presenting with febrile neutropenia--species distribution and susceptibility patterns.
abstract: OBJECTIVE
  Infections are a major cause of morbidity and mortality in pediatric cancer patients. The aim of this study was to establish the microbiological spectrum and the susceptibility patterns of bacteremia-causing bacteria in pediatric cancer patients with febrile neutropenia in relation to the use of prophylactic and empirical antibiotics.
  
  
  METHODS
  We analyzed positive blood cultures of pediatric cancer patients presenting with febrile neutropenia between 2004 and 2011 in Groningen and Amsterdam (the Netherlands) and in Bern (Switzerland), using different antibiotic prophylactic and empirical regimens.
  
  
  RESULTS
  A total of 156 patients with 202 bacteremias, due to 248 bacteria species, were enrolled. The majority (73%) of bacteremias were caused by Gram-positive bacteria. Gram-negative bacteria, especially Pseudomonas aeruginosa, were observed significantly more often in Bern, where no fluoroquinolone prophylaxis was used. Ciprofloxacin-resistant bacteria were cultured more often from patients who did receive ciprofloxacin prophylaxis, compared to the patients who did not (57 versus 11%, p = 0.044).
  
  
  CONCLUSIONS
  Gram-positive bacteria predominated in this study. We showed that the use of prophylactic antibiotics in pediatric cancer patients was associated with increased resistance rates, which needs further study. The strategy for empiric antimicrobial therapy for febrile neutropenia should be adapted to local antibiotic resistance patterns.
authors.affiliation: Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Karin G E
authors.initials: KG
authors.lastname: Miedema
authors.forename: Rik H L J
authors.initials: RH
authors.lastname: Winter
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
authors.forename: Sara
authors.initials: S
authors.lastname: Droz
authors.forename: Lodewijk
authors.initials: L
authors.lastname: Spanjaard
authors.forename: Eveline S J M
authors.initials: ES
authors.lastname: de Bont
authors.forename: Willem A
authors.initials: WA
authors.lastname: Kamps
authors.forename: Marianne D
authors.initials: MD
authors.lastname: van de Wetering
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D064147:Febrile Neutropenia / Q000382:microbiology* / Q000401:mortality; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000254:growth & development; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000254:growth & development; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D009426:Netherlands / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents