Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Etiology of Bacteremia in Children With Hemato-Oncologic Diseases From 2013 to 2023: A Single Center Study

  • Sun Woo Park (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Ji Young Park (Department of Pediatrics, Chung-Ang University Hospital, College of Medicine, Chung-Ang University) ;
  • Hyoung Soo Choi (Department of Pediatrics, Seoul National University Bundang Hospital) ;
  • Hyunju Lee (Department of Pediatrics, Seoul National University Bundang Hospital)
  • Received : 2023.10.27
  • Accepted : 2024.03.26
  • Published : 2024.04.25
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Abstract

Purpose: This study aimed to identify the pathogens of bloodstream infection in children with underlying hemato-oncologic diseases, analyze susceptibility patterns, compare temporal trends with those of previous studies, and assess empirical antimicrobial therapy. Methods: Retrospective review study of children bacteremia in hemato-oncologic diseases was conducted at Seoul National University Bundang Hospital from January 2013 to July 2023. Results: Overall, 98 episodes of bacteremia were observed in 74 patients. Among pathogens isolated, 57.1% (n=56) were Gram-positive bacteria, 38.8% (n=38) were Gram-negative bacteria, and 4.1% (n=4) were Candida spp. The most common Gram-positive bacteria were coagulase-negative staphylococci (n=21, 21.4%) and Staphylococcus aureus, (n=14, 14.3%) whereas the most common Gram-negative bacteria were Klebsiella pneumoniae (n=16, 16.3%) and Escherichia coli (n=10, 10.2%). The susceptibility of Gram-positive bacteria to penicillin, oxacillin, and vancomycin was 11.5%, 32.7%, and 94.2%, respectively and the susceptibility of Gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin, and amikacin was 68.6%, 80%, 97.1%, 82.9%, and 91.4%, respectively. Methicillin-resistant S. aureus was detected in 1 strain and among Gram-negative strains, extended spectrum β-lactamase accounted for 28.9% (12/38). When analyzing the antibiotic susceptibility and empirical antibiotics, the mismatch rate was 25.5% (n=25). The mortality rate of children within 30 days of bacteremia was 7.1% (n=7). Conclusions: Empirical antibiotic therapy for bacteremia in children with hemato-oncologic diseases should be based on the local antibiogram in each institution and continuous monitoring is necessary.

목적: 본 연구는 2013년부터 2023년까지 최근 10년간 분당서울대학교병원 소아 혈액종양 환자들에게 발생한 균혈증 발생 숫자를 확인하고, 원인균 발생 빈도 및 분포와 이들의 항생제 감수성을 분석하면서 경험적 항생제를 선택하는 데에 필요한 치료 지침의 기초 자료로 활용하고자 수행되었다. 방법: 2013년 1월부터 2023년 7월까지 분당서울대학교병원에 입원한 환자 중 기저혈액종양질환이 있으면서 혈류감염이 발생한 환자들을 대상으로 후향적 의무기록 분석을 하였다. 결과: 10년의 연구 기간동안 총 74명의 환자에게서 98례의 혈류감염이 확인되었고, 이 중 그람 양성균, 그람 음성균, 진균이 각각 57.1% (n=56), 38.8% (n=38), 4.1% (n=4)이었다. 가장 흔한 그람 양성균은 coagulase-negative staphylococci (n=21, 21.4%) 와 Staphylococcus aureus (n=14, 14.3%) 였고, 가장 흔한 그람 음성균은 Klebsiella species (n=16, 16.3%) 와 Escherichia coli (n=10, 10.2%) 였다. 전체 사망한 환자들 중 균혈증 발생으로부터 30일 이내로 사망한 사례는 총 6건 (6.1%) 이었다. 결론: 본 연구는 혈액종양질환을 진단받은 소아 환아들에게서 발생한 균혈증의 원인균 분포 및 각 원인균의 항생제 분포를 분석하였다. 연구결과를 토대로, 연구자들은 현재 사용하는 경험적 항생제 가이드라인을 유지할 수 있다는 점을 알 수 있었다. 소아 혈액종양질환 환아들에게서 발생한 균혈증에서 사용해야 할 적절한 경험적 항생제는 각 기관별로 조사한 항생제 감수성 양상에 기초하여 결정되어야 하며, 지속적인 모니터링은 반드시 이루어져야 한다.

Keywords

Acknowledgement

We would like to thank the team at the Department of Laboratory medicine of SNUBH for their support and providing bacteremia-surveillance data in this analysis.

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