소아 혈액 종양 환자에서 발생한 균혈증의 조사
Clinical Investigation of Bacteremia in Children with Hemato-Oncologic Diseases
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Backgroud: The purpose of this study was to determine the spectrum of locally prevalent pathogens and their susceptibility patterns responsible for bacteremia in pediatric hemato-oncologic patients for empiric antimicrobial therapy. Materials and Methods: A one-year retrospective study of pediatric hematooncologic patients with bacteremia in Seoul St. Mary’s Hospital, the Catholic University of Korea, from April 2009 to March 2010 was conducted using previous medical records. The findings were compared with our previous data obtained from 2004 to 2006. Results: Sixty-five episodes of bacteremia were recorded in 41 patients. Of them,55 (84.6%) occurred in neutropenic and 10 (15.4%) in non-neutropenic patients. Gram-positive organisms were more commonly isolated than Gram-negative organisms (56.9% vs. 41.5%) in the following order: viridans streptococci (23.1%),Klebsiella pneumoniae (21.6%), coagulase-negative staphylococci (12.3%),Staphylococcus aureus (7.7%), Enterococcus faecium (7.7%). Susceptibility rates of viridans streptococci to penicillin, cefotaxime and vancomycin were 33.3%, 60%and 100%, and those of Enterobacteriaceae to amikacin, ceftazidime, piperacillin/tazobactam and meropenem were 94.7%, 73.7%, 78.9%, and 100%, respectively. Compared to our previous data, infection still contributed towards a major fraction of mortality and morbidity in the management of patients with cancer. No differences in mortality rate were observed between isolated organisms from bacteremia. Conclusions: Gram-positive organisms were more prevalent than Gram-negative organisms in our population. The monitoring of causative agents and antimicrobial resistance should be considered in therapeutic strategies of pediatric hematooncologic infection.
Abstract
Backgroud: The purpose of this study was to determine the spectrum of locally prevalent pathogens and their susceptibility patterns responsible for bacteremia in pediatric hemato-oncologic patients for empiric antimicrobial therapy. Materials and Methods: A one-year retrospective study of pediatric hematooncologic patients with bacteremia in Seoul St. Mary’s Hospital, the Catholic University of Korea, from April 2009 to March 2010 was conducted using previous medical records. The findings were compared with our previous data obtained from 2004 to 2006. Results: Sixty-five episodes of bacteremia were recorded in 41 patients. Of them,55 (84.6%) occurred in neutropenic and 10 (15.4%) in non-neutropenic patients. Gram-positive organisms were more commonly isolated than Gram-negative organisms (56.9% vs. 41.5%) in the following order: viridans streptococci (23.1%),Klebsiella pneumoniae (21.6%), coagulase-negative staphylococci (12.3%),Staphylococcus aureus (7.7%), Enterococcus faecium (7.7%). Susceptibility rates of viridans streptococci to penicillin, cefotaxime and vancomycin were 33.3%, 60%and 100%, and those of Enterobacteriaceae to amikacin, ceftazidime, piperacillin/tazobactam and meropenem were 94.7%, 73.7%, 78.9%, and 100%, respectively. Compared to our previous data, infection still contributed towards a major fraction of mortality and morbidity in the management of patients with cancer. No differences in mortality rate were observed between isolated organisms from bacteremia. Conclusions: Gram-positive organisms were more prevalent than Gram-negative organisms in our population. The monitoring of causative agents and antimicrobial resistance should be considered in therapeutic strategies of pediatric hematooncologic infection.
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