Pathogenesis of bloodstream infection in children with blood cancer

The aim of the present study was to characterize the distribution and antibiotic resistance of pathogens isolated from patients with bloodstream infections (BSIs) in the Hematology and Oncology department of the Affiliated Children’s Hospital of Zhejiang University Medical School (Hangzhou, China), between January and December 2010 and to provide early and appropriate support for the clinical administration of antibiotics. Out of 1,500 inpatients, 161 children who were diagnosed with BSI based on the national diagnostic criteria were retrospectively analyzed. Neutropenia was defined as an absolute neutrophil count (ANC) in the peripheral blood of less than 0.5×10(9) cells/l. A microbiologically documented infection (MDI) was defined as when the causative pathogen was isolated from the blood. Drug susceptibility tests were performed using a VITEK-60 AutoMicrobic System and the Kirby-Bauer disk diffusion method. The data were analyzed using STATA software (version 9.0) and a two-sided P-value of ≤0.05 was considered to indicate a statistically significant difference. A total of 79 strains were isolated from the blood specimens. The incidence of BSI was 10.73% (161/1,500). Gram-positive cocci, Gram-negative bacilli and fungi accounted for 55.70, 43.04 and 1.27% of the BSIs, respectively. Staphylococcus epidermidis (20.25%), Escherichia coli (15.19%) and Klebsiella pneumoniae (15.19%) were frequently identified isolates. The staphylococci were susceptible to vancomycin and linezolid, while Escherichia coli and Klebsiella pneumoniae were sensitive to cefoperazone/sulbactam, imipenem and meropenem. In conclusion, Gram-positive bacteria are slightly more prevalent than Gram-negative bacteria in BSI and the selection of antibiotics according to the susceptibility test results is superior to empirical treatment. It is essential to administer antimicrobial agents early and appropriately to treat child blood cancer patients with BSI.