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Etiological agents isolated from blood in children with hemato-oncologic diseases (2002-2005)

Korean Journal of Pediatrics 2007;50(1):56-64.
Published online January 15, 2007.
Etiological agents isolated from blood in children with hemato-oncologic diseases (2002-2005)
So-Hee Kim1, Young-Ah Lee1, Byung-Wook Eun1, Nam-Hee Kim1, Jin-A Lee1, Hyoung Jin Kang2, Eun-Hwa Choi1, Hee Young Shin2, Hoan-Jong Lee1, Hyo Seop Ahn2
1Departments of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
2Departments of Cancer Research Institute Seoul National University College of Medicine, Seoul, Korea
소아 혈액 종양 환자에서 발생한 균혈증의 원인균(2002-2005년)
김소희1, 이영아1, 은병욱1, 김남희1, 이진아1, 강형진2, 최은화1, 신희명2, 이환종1, 안효섭2
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 암연구소
Correspondence: 
Hoan-Jong Lee, Email: hoanlee@snu.ac.kr
Abstract
Purpose
: This study was performed to identify the etiologic agents and antimicrobial susceptibility patterns of organisms responsible for bloodstream infections in pediatric cancer patients for guidance in empiric antimicrobial therapy.
Methods
: One hundred and ninety-seven episodes of bloodstream infections that developed in 128 pediatric cancer patients were analyzed, which were identified at the Seoul National University Children's Hospital during a 4 year-period from 2002 to 2005.
Results
: A total of 214 pathogens was isolated, of which 64.0 percent were gram-negative, 31.3 percent were gram-positive bacteria, and 4.7 percent were fungi. The most common pathogens were Klebsiella spp. (21 percent) and Escherichia coli (16.8 percent), and coagulase-negative staphylococci (CNS, 7.9 percent) and viridans streptococci (7.5 percent) emerged as important pathogens. Neutropenic patients were more often associated with gram-negative bacteria than non-neutropenic patients (67.5 percent vs. 51.1%, P=0.018) and patients with central venous catheters were more often associated with CNS and viridans streptococci than those without. Resistance rates of gram-positive bacteria to penicillin, oxacillin and vancomycin were 83.3 percent, 48.5 percent and 0.5 percent, respectively, and those of gram-negative bacteria to cefotaxime, piperacillin/tazobactam, imipenem, gentamicin and amikacin were 24.1 percent, 17.2 percent, 6.6 percent, 21.6 percent, and 14.2 percent, respectively. Gram-negative bacteremias were more often associated with intensive care than gram- positive bacteremias (26.5 percent vs. 10.3 percent, P=0.016), and patients with catheters were more often associated with intensive care (34.4 percent vs. 10.8 percent, P<0.001) and higher fatality rate (16.7 percent vs. 4.8 percent, P=0.012) than those without.
Conclusion
: This study revealed that gram-negative bacteria are still a dominant organism in bloodstream infections, especially in neutropenic patients, and confirmed that gram-positive bacteria are emerging as important etiological agents in bloodstream infections of pediatric hemato-oncologic patients.
Key Words: Bacteremia , Pediatric cancer , Neutropenia


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