title: Review of spectrum and sensitivity of bacterial bloodstream isolates in children with malignancy: A retrospective analysis from a single center.
abstract: BACKGROUND
  Febrile neutropenia is a life-threatening emergency in pediatric cancer patients. Its management is based on established guidelines that emphasize on prompt action. Consideration of local microbiologic spectrum and its susceptibility is pivotal in devising a rational protocol.
  
  
  OBJECTIVE
  To study the spectrum of bacterial isolates and its antibiotic sensitivity profile in bloodstream infections (BSIs) of pediatric cancer patients.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  This study was conducted at a tertiary cancer center for pediatric cancer patients. Blood culture samples sent during the evaluation of patients with clinical diagnosis of febrile neutropenia during the year of 2013 were analyzed. The microbiological and antibiotic sensitivity patterns were studied.
  
  
  RESULTS
  A total of 27 isolates represented BSIs out of 412 blood cultures sent (6.5%). These were predominantly Gram-negative (92%) with Klebsiella contributing to the majority of them. Extended spectrum beta-lactamase production was seen in 59% of all isolates. Multidrug resistance phenotype was seen in 48%, extreme drug resistance in 32% and pan drug resistance in 16% of Gram-negative isolates. Klebsiella predominated in all of these isolates. Mortality resulted in 15% isolates, majorly contributed by Klebsiella. Colistin was the most sensitive antibiotic (75% sensitivity) and in significant number of cases the only salvage option.
  
  
  CONCLUSIONS
  Gram-negative bacteria are the most common etiologic agents. The emergence of drug resistant strains of Klebsiella and the poor sensitivity of most of these strains to common first choice empiric agents is alarming. Low prevalence of Gram-positive organisms questions the routine use of empiric vancomycin.
authors: R
authors: R
authors: Reddy
authors: S
authors: S
authors: Pathania
authors: A
authors: A
authors: Kapil
authors: Department of Medical Oncology, All Institute of Medical Sciences, New Delhi, India.
authors: S
authors: S
authors: Bakhshi
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000150:complications; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D064147:Febrile Neutropenia / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification; D007710:Klebsiella Infections / Q000150:complications* / Q000401:mortality; D009369:Neoplasms / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin