Bloodstream infections (BSIs) adversely affect clinical outcome in children with cancer. Over 1 decade, this retrospective cohort study describes pathogen distribution in BSIs and antimicrobial susceptibility against empirical antibiotics frequently prescribed in children with cancer. The antibiotic efficacy was evaluated through the determination of minimal inhibitory concentrations for piperacillin-tazobactam and meropenem and by disk diffusion for remaining antibiotics. From 2004 to 2013, 398 BSIs occurred in 196 children with cancer (median age: 5.4 y), resulting in 457 bacteria. Overall, 266 (58.2%) were gram-positive, and 191 (41.8%) were gram-negative with a significant gram-positive increase over time (P=0.032). Coagulase-negative staphylococci (74, 16.2%), viridans group streptococci (67, 14.7%), Escherichia coli (52, 11.4%), and Staphylococcus aureus (39, 8.5%) were the most common pathogens. Susceptibility to piperacillin-tazobactam (95.9%, P=0.419) and meropenem (98.9%, P=0.752) was stable over time, and resistance was observed among viridans group streptococci against piperacillin-tazobactam (18%) and meropenem (7%) and among Enterobacterales against piperacillin-tazobactam (3%). Vancomycin showed 98% gram-positive activity, gentamicin 82% gram-negative activity and ampicillin, cefotaxime, and cefuroxime were active in 50%, 72%, and 69% of pathogens, respectively, and BSI-related mortality was 0%. In conclusion, over 1 decade, we report an increase in gram-positive BSIs, and stable, low-resistance rates against currently recommended empirical antibiotics, piperacillin-tazobactam and meropenem.

中文翻译：

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癌症儿童的血流感染：10 年期间的病原体分布和抗菌药物敏感性模式。

血流感染（BSI）对癌症儿童的临床结果产生不利影响。十多年来，这项回顾性队列研究描述了 BSI 中的病原体分布以及对癌症儿童常用的经验性抗生素的敏感性。通过测定哌拉西林-他唑巴坦和美罗培南的最低抑制浓度以及通过纸片扩散法评估剩余抗生素的抗生素功效。从2004年到2013年，196名癌症儿童（中位年龄：5.4岁）发生了398例BSI，产生了457个细菌。总体而言，266 例 (58.2%) 为革兰氏阳性，191 例 (41.8%) 为革兰氏阴性，且革兰氏阳性随时间显着增加 (P=0.032)。凝固酶阴性葡萄球菌（74 例，16.2%）、草绿色链球菌（67 例，14.7%）、大肠杆菌（52 例，11.4%）和金黄色葡萄球菌（39 例，8.5%）是最常见的病原体。对哌拉西林他唑巴坦（95.9%，P=0.419）和美罗培南（98.9%，P=0.752）的敏感性随时间推移保持稳定，并且草绿色群链球菌对哌拉西林他唑巴坦（18%）和美罗培南（7%）产生耐药性肠杆菌属对抗哌拉西林-他唑巴坦 (3%)。万古霉素对革兰氏阳性菌有 98% 的活性，庆大霉素对革兰氏阴性菌有 82% 的活性，氨苄西林、头孢噻肟和头孢呋辛分别对 50%、72% 和 69% 的病原体有活性，BSI 相关死亡率为 0%。总之，十多年来，我们报告革兰氏阳性 BSI 有所增加，并且对目前推荐的经验性抗生素、哌拉西林-他唑巴坦和美罗培南的耐药率稳定、低。