All issues > Volume 50(1); 2007

Original Article

Korean J Pediatr. 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 SH Kim¹, Young-Ah YA Lee¹, Byung-Wook BW Eun¹, Nam-Hee NH Kim¹, Jin-A JA Lee¹, Hyoung Jin HJ Kang², Eun-Hwa EH Choi¹, Hee Young HY Shin², Hoan-Jong HJ Lee¹, Hyo Seop HS 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

Correspondence Hoan-Jong HJ 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.

Keywords :Bacteremia , Pediatric cancer , Neutropenia