Prevalence, Epidemiology, Etiology, and Sensitivity of Invasive Bacterial Infections in Pediatric Patients Undergoing Oncological Treatment: A Multicenter Nationwide Study
Olga Zając‐Spychała, Jacek Wachowiak, Olga Gryniewicz–Kwiatkowska, Aneta Gietka, Bożenna Dembowska–Bagińska, Katarzyna Semczuk, Katarzyna Dzierżanowska‐Fangrat, K Czyźewski, Magdalena Dziedzic, Mariusz Wysocki, Patrycja Zalas‐Więcek, Anna Szmydki‐Baran, Łukasz Hutnik, Michał Matysiak, Filip Pierlejewski, Wojciech Młynarski, Zofia Małas, Wanda Badowska, Ninela Irga‐Jaworska, Ewa Bień, Elżbieta Drożyńska, Magdalena Bartnik, Tomasz Ociepa, Tomasz Urasiński, Paweł Wawryków, Jarosław Peregud‐Pogorzelski, Weronika Stolpa, Grażyna Sobol, Jowita Frączkiewicz, Małgorzata Salamonowicz, Bernarda Kazanowska, Alicja Chybicka, Liliana Chełmecka‐Wiktorczyk, Walentyna Balwierz, Iwona Żak, Zuzanna Gamrot‐Pyka, Mariola Woszczyk, Renata Tomaszewska, Tomasz Szczepański, Marcin Płonowski, Maryna Krawczuk‐Rybak, Agnieszka Urbanek‐Dądela, Grażyna Karolczyk, Jakub Musiał, Radosław Chaber, Jerzy Kowalczyk, Jan Styczyński
Abstract
Background: Infectious complications (IC) caused by bacterial strains often impede anticancer therapy. The study aimed to retrospectively analyze bacterial IC that could help predict the risk and optimize the empirical treatment for bacterial infections in pediatric cancer patients. Patients and Methods: Over a 72-month period, all-in 5,599 children with cancer: 2,441 patients with hematological malignancy (HM including acute leukemias, Hodgkin and non-Hodgkin lymphomas [NHLs], and Langerhans cell histiocytosis) and 3,158 with solid tumors (STs including central nervous system tumors, neuroblastoma, Wilms' tumor, soft tissue sarcoma, germ cell tumors, Ewing sarcoma, osteosarcoma, hepatoblastoma, and others) were enrolled into the study. Episodes of bacterial infectious complications (EBICs) confirmed by microbiological findings were reported by each hospital and analyzed centrally. Results: At least 1 EBIC was diagnosed in 2,155 (36.8%) children (1,281 [59.4%] with HM and 874 [40.6%] with ST; p < 0.001). All-in 4,860 EBICs were diagnosed including 62.2% episodes in children with HM and 37.8% in children with ST ( p < 0.001). Having analyzed the source of infections, blood stream infections predominated, apart from NHL patients in whom the most common type was gut infections. The profile of bacteria strains was different in HM and ST groups ( p < 0.001). However, in both groups the most common Gram-negative pathogen was Enterobacteriaceae, with the rate being higher in the HM group. Among Gram-negative strains low susceptibility to ceftazidime, whereas among Enterococcus spp. low susceptibility to vancomycin was noticed. The rate of multidrug-resistant (MDR) pathogens was high, especially for Gram negatives (47.7% vs. 23.9%; p < 0.001). The survival after infections was comparable for HM and ST patients ( p = 0.215). Conclusions: The risk of bacterial IC in HM patients was higher than in the ST group. The high rate of MDR strains was detected in pediatric cancer patients, especially in those with HM.