Background Our paediatric oncology unit serves a population of over 37 million. Reducing mortality secondary to neutropaenic sepsis is a central focus of quality-improvement efforts. Lack of routine microbiology investigations represents a major obstacle to rational choice of empiric therapy for febrile neutropaenia (FN) and appropriate individualised management when first line treatment fails.
Aims To investigate causes of blood-stream infections and local antibiotic sensitivity patterns in paediatric oncology patients treated for FN.
Methods We piloted routine use of blood cultures in children treated for FN over a 1-month period in May 2015. Peripheral blood cultures were taken from all potentially neutropaenic patients with fever ≥38°C prior to antibiotic treatment per local FN protocol. Sensitivity testing was performed manually and using BD Phoenix™ Automated Microbiology System.
Results There were 26 febrile episodes affecting 21 patients. Of 23 cultures performed, 5 (22%) demonstrated growth, all within 48 h. Three patients grew Staphylococcus areus; two grew Gram-negative organisms with sensitivity patterns consistent with extended-spectrum beta-lactamase (ESBL) expression. All three patients with S. aureus bacteraemia had clinically diagnosed soft tissue infection at a peripheral venous cannula site. All S. aureus isolates were methicillin-sensitive, but showed beta-lactamase activity and macrolide resistance. Both Gram-negative infections occurred in newly diagnosed leukaemia patients, one of whom was cultured immediately after transfer from another hospital. Both Gram-negative infections resulted in late septic deaths despite initial treatment with piperacillin-tazobactam/gentamicin followed by carbapenem/amikacin based on 48hr sensitivity results. Carbapenamase testing was unavailable.
Conclusions This audit demonstrated a high yield of virulent pathogens associated with an unacceptable level of infection-related morbidity and mortality. None of the organisms cultured were sensitive to antibiotics mentioned in the SIOP PODC FN guideline. There is a clear need to review cannula care practices. Emergence and uncontrolled spread of resistant organisms poses a serious threat to our ongoing ability to deliver curative chemotherapy. There is an urgent need to address infection control on a local and healthcare system level, and to acknowledge that microbiology services are an essential component of any viable oncology service and must be prioritised in resource-limited settings.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.