TY - JOUR
TI - Predictive Factors for Gram-negative Versus Gram-positive Bloodstream
Infections in Children With Cancer
AU - Sfetsiori, Angeliki-Eleni
AU - Doganis, Dimitrios
AU - Doudoulakakis,
AU - Anastasios
AU - Spyridis, Nikolaos
AU - Pourtsidis, Apostolos and
AU - Servitzoglou, Marina
AU - Nikita, Maria
AU - Papachristidou, Smaragda and
AU - Magkou, Evgenia
AU - Dana, Helen
AU - Lebessi, Evangelia
AU - Kosmidis,
AU - Helen
AU - Baka, Margarita
AU - Tsolia, Maria
JO - Journal of Pediatric Hematology / Oncology
PY - 2022
VL - 44
TODO - 2
SP - E368-E373
PB - Lippincott, Williams & Wilkins
SN - 1077-4114, 1536-3678
TODO - 10.1097/MPH.0000000000002253
TODO - Gram; bloodstream infection; predictive; risk factors
TODO - 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 and Methods: 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 1.7:1) versus boys
(Gram-negative/Gram-positive ratio 0.72:1), P=0.002, in patients with
previous BSI episodes (1.4:1) versus those without (0.8:1), P=0.042, and
in children with hematologic malignancy (1.3:1) versus those who
suffered from solid tumors (0.52:1), 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.
ER -