ArticleEuropean journal of pediatrics2026
Bacterial bloodstream infections in pediatric oncology patients in a tertiary medical center: pathogen distribution, antimicrobial nonsusceptibility, and outcomes.
Article in European journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The purpose of this study was to analyze bacterial bloodstream infections (BSIs) occurring in hospitalized pediatric hemato-oncology patients during 2012 to 2023. Data on 775 bacterial BSI episodes occurring in 456 patients (292, 63.04%, hematological malignancies and 164, 35.96%, solid tumors) were retrospectively collected and analyzed. In total, 362 (46.71%) bacterial-BSIs had profound neutropenia; 849 pathogens were isolated; gram-negative (GN) (68.78%, 584/849) were more common than gram-positive (GP) pathogens (30.86%, 262/849), P < 0.001. The most frequent GN isolates were Klebsiella spp. (20.38% of all isolates), Escherichia coli (19.20%), and Pseudomonas aeruginosa (12.01%); the most common GP isolates were Streptococcus viridans (9.19%) Enterococcus spp. (6.36%), and Staphylococcus aureus (6.12%, 21.15% MRSA). An increase in GN rates was observed in 2018-2023 versus 2012-2017 (74.16% vs. 63.22%, P = 0.001). Overall nonsusceptibility rates of Klebsiella spp. and E. coli were 80.13% and 90.07% for piperacillin, 16.76% and 9.82% for amikacin, 69.19% and 50.31% for ceftriaxone, 34.68% and 23.92% for piperacillin/tazobactam, and 8.72% and 1.85% for meropenem. Nonsusceptibility rates of Acinetobacter baumannii were 57.14% for both piperacillin/tazobactam and meropenem. The appropriateness of empiric antibiotic therapy (EAT) with piperacillin/tazobactam was lower than piperacillin/tazobactam + amikacin (62.61% vs. 90.45%, P < 0.0001). PICU admission was required in 230 (29.68%); 7-day and 30-day mortality rates were 6.36% and 14.69%, respectively.
conclusionsWe report an increase in GN-BSIs and in nonsusceptibility rates of Klebsiella spp. and E. coli to several first/second-line antibiotics used in empiric antibiotic therapy. In our setting, an EAT protocol including piperacillin/tazobactam and amikacin covered most pathogens and should be considered in stable children with suspicion of BSI. WHAT IS KNOWN: • Bloodstream infections and antibiotic resistance rates are increasing in pediatric hemato-oncology patients. WHAT IS NEW: • We found a dominance of gram-negative pathogens and moderate to high resistance rates of Klebsiella spp. and Escherichia coli for piperacillin/tazobactam, ciprofloxacin, and ceftriaxone. • Empiric antibiotic therapy was appropriate for 77.07% of evaluable pathogens. • The appropriateness of empiric antibiotic therapy with piperacillin/tazobactam alone was lower than that of piperacillin/tazobactam plus amikacin.
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