Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer.
J Pediatr Hematol Oncol
; 44(2): e368-e373, 2022 Mar 01.
Article
em En
| MEDLINE
| ID: mdl-34310469
ABSTRACT
BACKGROUND:
Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment. MATERIALS ANDMETHODS:
Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria.RESULTS:
Among 224 monomicrobial bacterial BSI episodes, Gram-negative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.71) versus boys (Gram-negative/Gram-positive ratio 0.721), P=0.002, in patients with previous BSI episodes (1.41) versus those without (0.81), P=0.042, and in children with hematologic malignancy (1.31) versus those who suffered from solid tumors (0.521), P=0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P=0.009, neutrophils, P=0.009 and platelets, P=0.002, but with significantly higher C-reactive protein (CRP) levels, P=0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis.CONCLUSIONS:
Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por Bactérias Gram-Positivas
/
Infecções por Bactérias Gram-Negativas
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Bacteriemia
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Sepse
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Neoplasias Hematológicas
/
Neoplasias
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Child
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Female
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Humans
/
Male
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article