Increase in Antibiotic-Resistant Gram-Negative Bacterial Infections in Febrile Neutropenic Children.
- Author:
Joon Hee LEE
1
;
Seul Ki KIM
;
Seong Koo KIM
;
Seung Beom HAN
;
Jae Wook LEE
;
Dong Gun LEE
;
Nack Gyun CHUNG
;
Bin CHO
;
Dae Chul JEONG
;
Jin Han KANG
;
Hack Ki KIM
Author Information
- Publication Type:Original Article
- Keywords: Fever; Neutropenia; Bacteremia; Antibiotic resistance; Child
- MeSH: Bacteremia; Bacteria; Bacterial Infections; Child*; Drug Resistance, Microbial; Epidemiology; Escherichia coli; Fever; Gram-Negative Bacteria; Gram-Negative Bacterial Infections*; Gram-Positive Bacteria; Humans; Incidence; Klebsiella; Medical Records; Methicillin Resistance; Mortality; Neutropenia; Pneumonia; Prognosis; Retrospective Studies; Viridans Streptococci
- From:Infection and Chemotherapy 2016;48(3):181-189
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: The incidence of bacteremia caused by Gram-negative bacteria has increased recently in febrile neutropenic patients with the increase of antibiotic-resistant Gram-negative bacterial infections. This study aimed to identify the distribution of causative bacteria and the proportion of antibiotic-resistant bacteria in bacteremia diagnosed in febrile neutropenic children. MATERIALS AND METHODS: The medical records of febrile neutropenic children diagnosed with bacteremia between 2010 and 2014 were retrospectively reviewed. The causative bacteria and proportion of antibiotic-resistant bacteria were investigated and compared yearly during the study period. The clinical impact of antibiotic-resistant bacterial infections was also determined. RESULTS: A total of 336 bacteremia episodes were identified. During the entire study period, 181 (53.9%) and 155 (46.1%) episodes were caused by Gram-negative and Gram-positive bacteria, respectively. Viridans streptococci (25.9%), Klebsiella spp. (16.7%), and Escherichia coli (16.4%) were the most frequent causative bacteria. The overall distribution of causative bacteria was not significantly different annually. Antibiotic-resistant bacteria were identified in 85 (25.3%) episodes, and the proportion of antibiotic-resistant bacteria was not significantly different annually. Extended-spectrum β-lactamase-producing E. coli and Klebsiella spp. were most common among antibiotic-resistant Gram-negative bacteria, and they accounted for 30.6% (n = 34) of the identified E. coli and K. pneumoniae. Methicillin-resistant coagulase-negative staphylococci were most common among antibiotic-resistant Gram-positive bacteria, and it accounted for 88.5% (n = 23) of the identified coagulase-negative staphylococci. Antibiotic-resistant bacterial infections, especially antibiotic-resistant Gram-negative bacterial infections, caused significantly higher mortality due to bacteremia compared with non-antibiotic-resistant bacterial infections (P <0.001). CONCLUSION: Recently, Gram-negative bacteria caused more bacteremia cases than Gram-positive bacteria in febrile neutropenic children, and antibiotic-resistant Gram-negative bacterial infections increased. Antibiotic-resistant bacterial infections caused poorer prognosis compared with non-antibiotic-resistant bacterial infections, and therefore, continuous surveillance for changing epidemiology of antibiotic-resistant bacterial infections and their clinical impact is necessary.
