title: Invasive bacterial infections in a pediatric oncology unit in a tertiary care center.
abstract: BACKGROUND
  Multidrug resistant (MDR) pathogens are becoming a major problem worldwide, more so in the immunocompromised hosts resulting in the urgent need of antibiotic stewardship.
  
  
  OBJECTIVE
  To analyze the organisms isolated and the drug resistance pattern in a pediatric oncology unit.
  
  
  RESULTS
  Data pertaining to infections with 128 positive cultures in patients with febrile neutropenia over a period of 1-year are presented. The unit antibiotic policy is decided depending on the sensitivity of the prevailing common organisms. We isolated Gram-negative organisms in 56% cases. Escherichia coli and Klebseilla were the most frequent lactose fermenting Gram-negative Bacilli and Pseudomonas and Acinetobacter the nonfermenting Gram-negative Bacilli. Only 20-30% of the Gram-negative organisms cultured were sensitive to a 3rd/4th generation cephalosporin. The combination of a beta-lactam/inhibitor covered 2/3rd of Gram-negative organisms. About 80% of the organisms were sensitive to carbapenems. There was no colistin resistance. About 44% of our cultures grew a Gram-positive bacterial organism and included coagulase negative Staphylococcus. We had an incidence of methicillin resistant Staphylococcus aureus to be 30%. About 30% of the enterococci isolated in our unit were vancomycin-resistant enterococci. About 23% of patients with a positive bacterial culture died.
  
  
  CONCLUSIONS
  Infections in pediatric cancer patient's account for about 15-20% of the deaths in developing countries as these patients are at a high risk for developing MDR infections. Resistance rates among Gram-positive and Gram-negative organisms have increased worldwide. Every unit needs a rational antibiotic policy. Antibiotic de-escalation and judicious decrease in the duration of antibiotics needs to be practiced.
authors: Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors: A
authors: A
authors: Trehan
authors: S
authors: S
authors: Totadri
authors: V
authors: V
authors: Gautam
authors: D
authors: D
authors: Bansal
authors: P
authors: P
authors: Ray
mesh_terms: D000151:Acinetobacter Infections / Q000382:microbiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D018550:Cephalosporin Resistance; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D004927:Escherichia coli Infections / Q000382:microbiology; D064147:Febrile Neutropenia / Q000150:complications* / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology* / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007710:Klebsiella Infections / Q000382:microbiology; D008495:Medical Oncology; D009369:Neoplasms / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D011552:Pseudomonas Infections / Q000382:microbiology; D013203:Staphylococcal Infections / Q000382:microbiology; D062606:Tertiary Care Centers; D047090:beta-Lactams / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams