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A 5-year-old girl with acute lymphoblastic leukaemia is receiving empirical intravenous antibiotic treatment for febrile neutropenia. On day 2 of her admission you are notified from the microbiology laboratory that she has a blood culture positive with a Gram-negative bacillus. You wonder if she has risk factors for antibiotic resistant Gram-negative bacteraemia and if her empirical antibiotic therapy should be adjusted.
Structured clinical question
In a child with cancer (patient) what risk factors (‘intervention’) affect probability of growth of an antibiotic resistant Gram-negative organism in blood culture (outcome) in comparison to growth of a sensitive Gram-negative organism (comparison).
Medline was searched via the Healthcare Databases Advanced Search interface (1950 to present, limited to publications in English) using the search terms: (cancer OR oncolog*) AND ((antimicrob* AND resistan*) OR (antibiotic* AND resistan*) OR MDR OR ((multidrug OR multi-drug) AND resistan*) OR MRO OR multi-resistan* OR multiresistan*) AND (paed* OR ped* OR child*). One author (IL) assessed the title and abstract of each reference identified by the search. For potentially relevant articles, the full text was obtained and assessed by both authors for inclusion in the review. The reference lists of all relevant articles were also screened.
A total of 275 titles and abstracts were reviewed of which 17 full text articles were retrieved. Four articles addressed the clinical question and were included in the review.1–4 An additional relevant article was identified on screening the reference lists.5
Thirteen articles were excluded as they did not address the clinical question or supply sufficient information that could be extracted. The search date was 10 December 2014. The relevant papers are summarised in table 1.
Bacteraemia is identified in up to a quarter of all …