Increasing Antimicrobial Resistance Monitored in Surveillance Analysis of Blood Stream Infections in Febrile Neutropenic Pediatric Oncology Patients

摘要

Background: Continuous surveillance of pattern of blood stream infection is necessary in febrile neutropenia(FN)especially with the recent escalating trend in the management of pediatric cancer patients towards intensifiedregimens and with the increase in infections caused by resistant organisms limiting the choice of antibiotics.Aim: To monitor change in pattern of blood stream infections (BSI) in FN pediatric cancer patients. Materialsand Methods: Surveillance of FN episodes with positive BSI was prospectively monitored and compared to aprevious surveillance in the same pediatric oncology unit. Results: A total of 232 BSI positive episodes weredocumented in 192 patients during a 6 months period. The results of recent surveillance analysis showed anincrease in intensified regimens of chemotherapy, antimicrobial resistance, fungal infections, and prolongedduration of episodes when compared to previous surveillance, with p value sof <0.001, 0.005, 0.021, and <0.001,respectively. There was an apparent decrease in the crude mortality but this was not statistically significant, to6% in 2011 from 10 % in 2006. Conclusions: The pattern of BSI at our institution is still inclining towards grampositive organisms but is showing a shift towards more antibiotic resistance and fungal infections.