Bacteremia Pathogens in Febrile Neutropenia among Children with Cancer, Vientiane Capital, Lao PDR

Khounthavy Phongsavath; Pope Kosalaraksa; Surapon Wiangnon; Mayfong Mayxay; Bandith Soumphonphakdy; Bounpalisone Souvanlasy

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Bacteremia Pathogens in Febrile Neutropenia among Children with Cancer, Vientiane Capital, Lao PDR

Author: Khounthavy Phongsavath ¹ ; Pope Kosalaraksa ² ; Surapon Wiangnon ² ; Mayfong Mayxay ³ ; Bandith Soumphonphakdy ⁴ ; Bounpalisone Souvanlasy ⁵
Author Information

1. Department of pediatrics, Faculty of medicine, University of Health sciences, Lao PDR.
2. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand.
3. Director office, University of Health Sciences, Vientiane Capital, Lao PDR
4. The Infectious Diseases Department of Mahosot hospitals in Vientiane Capital, Lao PDR.
5. Hematology and Oncology Department, Children’s Hospital, Vientiane Capital, Lao PDR
Collective Name:LMJ
Publication Type:Journal Article
Keywords: bacteremia pathogens, childhood cancer, febrile neutropenia (FN), antibiotic susceptibility
From:Lao Medical Journal 2023;14(14):57-63
CountryLao People's Democratic Republic
Language:English
Abstract: Background: :Cancer patients with febrile neutropenia (FN) at risk of life-threatening sepsis, and require immediate empirical antibiotic therapy. Appropriate empirical therapy is a key factor for the management. 48% to 60% of childhood cancer patients with FN have infections. Bacteremia was found in 10-50% of all patients with febrile neutropenia.
Objective: :To investigate the causative bacteremia Pathogens in children with cancer during febrile neutropenia at children hospital, Vientiane, Lao PDR.
Methods: :A cross-sectional descriptive study was conducted to investigate the bacterial pathogens responsible for febrile neutropenia (FN) in children under 15 years of age undergoing chemotherapy for cancer. The study was carried out at the Department of Pediatric Hemato-oncology, Children's Hospital, Vientiane, Laos, from October 2021 to September 2022.
Results: :A prospective study involving 162 FN episodes was undertaken. The most prevalent underlying malignancy was acute lymphoblastic leukemia (ALL), accounting for (78.40%) of cases. Clinical presentations associated with FN included pneumonia 21%. Febrile neutropenia without an identified source accounted for 58.02% of FN episodes. Severe neutropenia was observed in 59.88% of FN episodes. The frequency of bacteremia was 19.14%. Gram-negative organisms constituted 83.87% of infections, with E. coli being the most frequently isolated pathogen 29.03%. Other gram-negative organisms included Klebsiella pneumoniae, Pseudomonas aeruginosa, Burkholderia pseudomallei, and Acinetobacter baumannii. Fifty percent of E. coli and K. pneumoniae exhibited extended-spectrum beta-lactamase (ESBL) production. All ESBL-producing organisms were susceptible to meropenem and amikacin. Gram-positive organisms accounted for 16.13% of infections, with methicillin-resistant Staphylococcus aureus (MRSA) being the most prevalent 6.45%. Half of the Gram-negative organisms showed sensitivity to ceftazidime, and they were all 100% sensitive to aminoglycosides, particularly amikacin and meropenem.
Conclusion: :Within the context of febrile neutropenia, the frequency of bacteremia was found to be 19.14%. The most common primary causative organism was E. coli. Based on these findings, we recommend that for low-risk patients with FN, the initial empiric antibiotic regimen should consist of ceftazidime and amikacin. For high-risk patients or those hospitalized for extended periods, the most suitable empiric antibiotic regimen is meropenem combined with amikacin.
Full text:2026030212222636913ບົດທີ_06. Khounthavy edith manualscript_(LMJ_14).pdf