Alarming Upward Trend in Multidrug-Resistant Bacteria in a Large Cohort of Immunocompromised Children: A Four-Year Comparative Study

SIMPLE SUMMARY: Infection is the second leading cause of death in patients with cancer. The emergence of multidrug resistant bacteria is an ongoing problem, leading to difficulties in the treatment of antibiotic resistant bacterial infections. Our main objective was to document the evolution of multidrug resistant bacteria in a tertiary centre in Lyon, France, which was initially stable between 2014 and 2017 in a study conducted by Raad C. et al. (2021). Following 2017, multidrug resistant bacteria seem to increase gradually in bloodstream infections and in digestive colonisations in a similar cohort in the same tertiary centre, considering that the antibiotic management did not change over the eight years. We want to raise awareness among health practitioners and to incite other similar centres to study their tendencies of multidrug resistant bacteria in order to avoid dangerous multidrug resistant infections in immunocompromised children with a rather good prognostic otherwise. ABSTRACT: Documenting bacteremia at the onset of fever in immunosuppressed children is challenging; therefore, it leads to the early administration of broad-spectrum antibiotics. We aimed to analyse the evolution of antibiotic resistance profiles of bacterial bloodstream infections (BSI) and gut colonisations in a large cohort of immunocompromised children carrying a central venous catheter, in comparison with a prior, similar study conducted in our centre from 2014 to 2017. A retrospective, observational cohort study was conducted from January 2018 to December 2021, in a tertiary centre for paediatric immuno-haematology and oncology. Empirical antibiotic therapy was adapted to the immunosuppression risk group and prior bacterial colonisation. There was a mean of 6.9 BSI/1000 patient bed days. Multidrug-resistant bacteria (MDRB) associated BSI accounted for 35/273 (12.8%). The incidence of MDRB gum/gut colonisation and MDRB associated BSI increased annually and correlated with the level of immunosuppression (p = 0.024). One third (34.7%) of the BSI episodes were not associated with neutropenia. As compared to the previous study, an alarming emergence of MDRB responsible for gut colonisations and BSI in immunosuppressed children was reported over the last four years. The degree of immunosuppression directly correlates with the risk of having an MDRB gut colonisation or MDRB BSI.