ÇOCUK HEMATOLOJİ/ONKOLOJİ HASTALARINDA PSEUDOMONAS SPP. KAN DOLAŞIM ENFEKSİYONLARININ ÖZELLİKLERİNİN DEĞERLENDİRİLMESİ

Öz

Pseudomonas spp. febril nötropenik hastalarda bakteriyemide en sık görülen üçüncü Gram negatif etkendir. Artan direnç oranları hastaların hastanede kalış süresinin uzamasına, artan tedavi maliyetlerine ve mortaliteye neden olmaktadır. Çalışmamızda, hemotoloji/onkoloji servisinde yatan ve kan kültüründe Pseudomonas spp. üremesi olan çocuk hastaların demografik özelliklerini, klinik özelliklerini, antibiyotik direnç oranlarını, mortalite oranını ve prognozunu değerlendirmeyi amaçladık. Çalışmamızda 2007-2021 yılları arasında hematoloji/onkoloji servisinde yatarak izlenen 0-18 yaş arası ve kan kültüründe Pseudomonas spp. üremesi olan hastalar retrospektif olarak değerlendirildi. Çalışmaya dahil edilen 16 hastanın medyan yaşı 32.5 ay (IQR: 78 ay) idi ve hastaların %50’si erkekti. Hastalarda altta yatan en sık hastalıklar sırasıyla %43.8 (n=7) oranıyla akut lenfoblastik lösemi, %31.5 (n=5) oranıyla nöroblastom, %12.5 (n=2) oranıyla akut myeloblastik lösemi, %6.3 (n=1) oranlarıyla medulloblastom ve osteosarkomdu. Hastaların %93.8’inde (n=15) ateş yüksekliği, %18.8’inde (n=3) mukozit ve %37.5’unda (n=6) anal lezyon mevcuttu. Hastaların %81.3’ünde (n=13) santral venöz kateter mevcuttu. Nötropeni olguların %68.8’inde (n=11) vardı ve üreme öncesi medyan nötropeni süresi 7 (IQR: 12.2) gündü. Üremeler antibiyotik duyarlılıkları açısından değerlendirildiğinde üremelerin hepsi seftazidim, sefepim, siprofloksasin, tobramisine duyarlıydı. Üremelerin %12.5’inde (n=2) karbapenem direnci vardı. Hastaların izleminde %12.5’nin (n=2) yoğun bakım ve inotrop, %6.3’ünün (n=1) mekanik ventilasyon ihtiyacı olmuştu. Hastaların 14-gün ile 30-günlük mortalite oranı %6.3 (n=1) idi. Çalışmamızda Pseudomonas spp. üremesi olan hastaların çoğunun nötropenik olduğunu ve çoğunun port kateterinin olduğunu görülmüştür. Hastalarımızdan izole edilen Pseudomonas spp. suşlarının antibiyotiklere karşı duyarlılık oranları değerlendirildiğinde üremelerin hepsinin seftazidim, sefepim, siprofloksasin, tobramisine duyarlı olduğunu ve mortalite oranının literatüre göre düşük olduğunu gözlenmiştir.

Anahtar Kelimeler

• Çocuk
• Hematoloji
• Onkoloji
• Pseudomonas spp.

Evaluation of the Characteristics of Pseudomonas spp. Bloodstream Infections in Pediatric Hematology/Oncology Patients

Öz

Pseudomonas spp. is the third most common Gram negative agent for bacteremia in febrile neutropenic patients. Increasing resistance rates cause prolonged hospitalization, increased treatment costs, and mortality. We aimed to determine the demographic characteristics, clinical features, antibiotic resistance rates, mortality, and prognosis of pediatric patients with Pseudomonas spp. bacteremia in the hematology/oncology ward. A retrospective study was conducted to evaluate patients aged 0-18 years with Pseudomonas spp. bacteremia between 2007-2021 in the hematology/oncology ward. A total of 16 patients with Pseudomonas spp. bacteremia was evaluated. The median age of patients was 32.5 months (IQR: 78 months), and 50% were male. The most common underlying disease was acute lymphoblastic leukemia (43.8%, n=7), neuroblastoma (31.5%, n=5), acute myeloblastic leukemia (12.5%, n=2), medulloblastoma (6.3%, n=1) and osteosarcoma (6.3%, n=1), respectively. Fever was present in 93.8% (n=15) of the patients, mucositis in 18.8% (n=3), and anal lesion in 37.5% (n=6). There was a central venous catheter in 81.3% (n=13) of the patients. Neutropenia was present in 68.8% (n=11) of the cases, and the median duration of neutropenia before bacteremia was 7 (IQR: 12.2) days. When antibiotic susceptibility was evaluated, all of the isolates were sensitive to ceftazidime, cefepime, ciprofloxacin, and tobramycin. Carbapenem resistance was 12.5% (n=2). In the follow-up, 12.5% (n=2) of the patients required intensive care and inotropic support, and 6.3% (n=1) required mechanical ventilation. The 14-day and 30-day mortality rate of the patients was 6.3% (n=1). In our study, most of the patients with Pseudomonas spp. bacteremia was neutropenic, and most of them had a port catheter. When the antimicrobial susceptibility rates were evaluated, it was observed that all the isolates were susceptible to ceftazidime, cefepime, ciprofloxacin, and tobramycin; and the mortality rate was lower than in the literature.

Anahtar Kelimeler

• Child
• Hematology
• Oncology
• Pseudomonas spp.

Kaynakça

1. 1. Al-Mulla NA, Taj-Aldeen SJ, El Shafie S, Janahi M, Al-Nasser AA, Chandra P. Bacterial bloodstream infections and antimicrobial susceptibility pattern in pediatric hematology/oncology patients after anticancer chemotherapy. Infect Drug Resist. 2014;7:289-99. https://doi.org/10.2147/IDR.S70486
2. 2. Averbuch D, Avaky C, Harit M, et al. Non-fermentative gram-negative rods bacteremia in children with cancer: a 14-year single-center experience. Infection 2017;45(3):327-34. https://doi.org/10.1007/s15010-017-0988-1
3. 3. Bodro M, Sabé N, Tubau F, et al. Extensively drug-resistant Pseudomonas aeruginosa bacteremia in solid organ transplant recipients. Transplantation. 2015;99(3):616-22. https://doi.org/10.1097/TP.0000000000000366
4. 4. Boeriu E, Borda A, Vulcanescu DD, et al. Diagnosis and management of febrile neutropenia in pediatric oncology patients-A systematic review. Diagnostics (Basel). 2022;12(8):1800. https://doi.org/10.3390/diagnostics12081800
5. 5. Caselli D, Cesaro S, Ziino O, et al. Infection Study Group of the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP). Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation. Haematologica. 2010;95(9):1612-5. https://doi.org/10.3324/haematol.2009.020867
6. 6. Kim HS, Park BK, Kim SK, et al. Clinical characteristics and outcomes of Pseudomonas aeruginosa bacteremia in febrile neutropenic children and adolescents with the impact of antibiotic resistance: a retrospective study. BMC Infect Dis. 2017;17(1):500. https://doi.org/10.1186/s12879-017-2597-0
7. 7. Kishimoto K, Kasai M, Kawamura N, Otake S, Hasegawa D, Kosaka Y. Clinical characteristics and risk factors for mortality in children with Pseudomonas aeruginosa bacteraemia: A retrospective review at a paediatric tertiary centre. J Paediatr Child Health. 2021;57(12):1976-80. https://doi.org/10.1111/jpc.15634
8. 8. Lehrnbecher T, Averbuch D, Castagnola E, et al. 8th European Conference on Infections in Leukaemia: 2020 guidelines for the use of antibiotics in paediatric patients with cancer or post-haematopoietic cell transplantation. Lancet Oncol. 2021;22(6):e270-e80. https://doi.org/10.1016/S1470-2045(20)30725-7

9. 9. Mattei D, Baretta V, Mazzariol A, et al. Characteristics and outcomes of bloodstream infections in a tertiary-care pediatric hematology-oncology unit: A 10-year study. J Clin Med. 2022;11(3):880. https://doi.org/10.3390/jcm11030880
10. 10. Miedema KG, Winter RH, Ammann RA, et al. Bacteria causing bacteremia in pediatric cancer patients presenting with febrile neutropenia--species distribution and susceptibility patterns. Support Care Cancer. 2013;21(9):2417-26. https://doi.org/10.1007/s00520-013-1797-4
11. 11. Raad C, Behdenna A, Fuhrmann C, et al. Trends in bacterial bloodstream infections and resistance in immuno-compromised patients with febrile neutropenia: a retrospective analysis. Eur J Pediatr. 2021;180(9):2921-30. https://doi.org/10.1007/s00431-021-04056-5
12. 12. Stergiotis M, Ammann RA, Droz S, Koenig C, Agyeman PKA. Pediatric fever in neutropenia with bacteremia-Pathogen distribution and in vitro antibiotic susceptibility patterns over time in a retrospective single-center cohort study. PLoS One. 2021;16(2):e0246654. https://doi.org/10.1371/journal.pone.0246654
13. 13. Tan X, Li Y, Xi J, et al. Comparative efficacy and safety of antipseudomonal β-lactams for pediatric febrile neutropenia: A systematic review and Bayesian network meta-analysis. Medicine (Baltimore). 2021;100(50):e27266. https://doi.org/10.1097/MD.0000000000027266
14. 14. European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 12.0. 2022. Available at: http://www.eucast.org.
15. 15. Zhao Y, Lin Q, Liu L, et al. Risk Factors and Outcomes of Antibiotic-resistant Pseudomonas aeruginosa Bloodstream Infection in Adult Patients With Acute Leukemia. Clin Infect Dis. 2020;71(Suppl 4):S386-93. https://doi.org/10.1093/cid/ciaa1522
16. 16. Akyol D, Karatas M, Aydemir S, et al. Antibacterial resistance patterns and incidence of nosocomial Pseudomonas aerugınosa bacteremia in a tertiary-care educational hospital in Turkey: a perspectıve between 2001 and 2019. Acta Medica Mediterranea. 2022;38:985. https://doi.org10.19193/0393-6384_2022_2_151
17. 17. Özdemir B, Akıncı E, But A, et al. Bloodstream infections in severe burn patients: Epidemiology, microbiology, laboratory features, and risk factors associated with ortality. Mediterr J Infect Microb Antimicrob. 2022;11:47. http://dx.doi.org/10.4274/mjima.galenos.2022.2022.47