title: Antibiotic-resistant Gram-negative bacteremia in pediatric oncology patients--risk factors and outcomes.
abstract: BACKGROUND
  Infection with antibiotic-resistant (AR) Gram-negative (GN) bacteria is associated with increased morbidity and mortality. The aim of this study was to determine risk factors and outcomes associated with GN bacteremia with acquired resistance to antibiotics used in the empiric treatment of febrile neutropenia in pediatric oncology patients at our institution.
  
  
  METHODS
  All episodes of GN bacteremia in oncology patients at the Royal Children's Hospital Melbourne, from 2003 to 2010 were retrospectively reviewed. Information regarding age, diagnosis, phase of treatment, inpatient status, previous AR GN infection, treatment with inotropes or ventilatory support, admission to intensive care unit, and hospital and intensive care unit length of stay were obtained from electronic records.
  
  
  RESULTS
  A total of 280 episodes of GN bacteremia in 210 patients were identified. Of these, 42 episodes in 35 patients were caused by an AR GN organism. Factors independently associated with AR GN bacteremia were high-intensity chemotherapy (odds ratio 3.7, 95% confidence interval: 1.2-11.4), hospital-acquired bacteremia (odds ratio 4.3, 95% confidence interval: 2.0-9.6) and isolation of AR GN bacteria from any site within the preceding 12 months (odds ratio 9.9, 95% confidence interval: 3.8-25.5). Episodes of AR GN bacteremia were associated with longer median hospital length of stay (23.5 days versus 14.0 days; P = 0.0007), longer median intensive care unit length of stay (3.8 days versus 1.6 days; P = 0.02) and a higher rate of invasive ventilation (15% versus 5.2%; P = 0.03). No significant difference in infection-related or all-cause mortality between the 2 groups was identified.
  
  
  CONCLUSIONS
  In pediatric oncology patients, AR GN bacteremia is associated with an increased rate of adverse outcomes and is more likely in patients who have received high-intensity chemotherapy, have been in hospital beyond 48 hours and who have had previous AR GN infection or colonization.
authors.affiliation: Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, Australia. gabrielle.haeusler@rch.org.au
authors.forename: Gabrielle M
authors.initials: GM
authors.lastname: Haeusler
authors.forename: Francoise
authors.initials: F
authors.lastname: Mechinaud
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Daley
authors.forename: Mike
authors.initials: M
authors.lastname: Starr
authors.forename: Frank
authors.initials: F
authors.lastname: Shann
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Connell
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Bryant
authors.forename: Susan
authors.initials: S
authors.lastname: Donath
authors.forename: Nigel
authors.initials: N
authors.lastname: Curtis
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000150:complications*; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents