Characteristics and Outcomes of Bloodstream Infections in a Tertiary-Care Pediatric Hematology–Oncology Unit: A 10-Year Study

Abstract

Bloodstream infections (BSIs) after chemotherapy or hematopoietic stem cell transplantation (HSCT) are a leading cause of morbidity and mortality. Data on 154 BSIs that occurred in 111 onco-hematological patients (57 hematological malignancies, 28 solid tumors, and 26 non-malignant hematological diseases) were retrospectively collected and analyzed. Monomicrobial Gram-positive (GP), Gram-negative (GN), and fungal BSIs accounted for 50% (77/154), 38.3% (59/144), and 3.2% (5/154) of all episodes. Polymicrobial infections were 7.8% (12/154), while mixed bacterial-fungal infections were 0.6% (1/154). The most frequent GN isolates were <i>Escherichia coli</i> (46.9%), followed by <i>Pseudomonas aeruginosa</i> (21.9%), <i>Klebsiella</i> species (18.8%), and <i>Enterobacter</i> species (6.3%). Overall, 18.8% (12/64) of GN organisms were multidrug-resistant (seven <i>Escherichia coli</i>, three <i>Klebsiella pneumoniae</i>, and two <i>Enterobacter cloacae</i>), whereas GP resistance to glycopeptides was observed in 1% (1/97). Initial empirical antibiotic therapy was deemed inappropriate in 12.3% of BSIs (19/154). The 30-day mortality was 7.1% (11/154), while the bacteremia-attributable mortality was 3.9% (6/154). In multivariate analysis, septic shock was significantly associated with 30-day mortality (<i>p</i> = 0.0001). Attentive analysis of epidemiology and continuous microbiological surveillance are essential for the appropriate treatment of bacterial infections in pediatric onco-hematological patients.