High prevalence and multidrug resistance of gram-negative bloodstream infections in children with acute myeloid leukemia

BackgroundIn children receiving therapy for acute myeloid leukemia (AML), gram-negative bacteremia is associated with significant morbidity and mortality, especially in the presence of multi-drug resistant [MDR] organisms. objectives: The purpose of this study was to determine the prevalence and antibiotic susceptibility patterns of gram negativebloodstream infections [GNBSI]] during the period of induction chemotherapy [IC] and the associated morbidity and mortality in a large pediatric oncology hospital in a low- middle-income country (LMIC). patients and methods: This is a retrospective analysis of consecutive newly diagnosed patients with acute myeloid leukemia (AML) admitted for induction chemotherapy (IC) from January 2015 to December 2017 at the Children’s Cancer Hospital Egypt 57357.ResultsWe identified 90[27.4%] children with at least one GNBSI during induction, 72/90[80%] of whom had at least one MDR GNBSI. 124 GNBSI episodes were identified among the ninety children: E.coli 54.8%, K.pneumoniae 16.9%, A.baumannii 6.5%, E.cloacae 4.8%, and P.aeruginosa 4.0%. Thirty-day cumulative infection-related mortality was 27.8% [18.9-37.3%]. Associated morbidity included typhlitis [29/90 (32.2%)], sepsis-related central venous catheter [CVC] removal [12/90 (13.3%)], and admission to intensive care unit [38/90(42%)]. ConclusionOur study highlights the prevalence of gram-negative bacteria among febrile neutropenic children with AML and the high incidence of antibiotic resistance in our hospital. There is a need for keen surveillance globally of the epidemiology of multi-drug resistant gram-negative organisms and thoughtful studies into antibiotic stewardship to reduce the growing threat of MDR GN infections and the associated morbidity and mortality.