الفهرس 
PEDIATRIC MALIGNANCYOnly 14 pages are availabe for public view
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Abstract
Cancer is a large group of diseases that can start in almost any organ or tissue of the body when abnormal cells grow uncontrollably, it is the second leading cause of death globally.
Pediatric patients with cancer are at great risk of infection either from disease process or after being immuno-suppressed by chemotherapy and radiotherapy, this is especially with non-pathogenic gram negative and multidrug resistant (MDR) pathogens.
This raises the need for careful local antibiotic stewardship and infection control programs
The current study was conducted to detect the frequency and risk factors of multidrug resistant gram negative bacteria (MDR-GNB) infections at the Pediatric Oncology Department and to identify the patterns of resistance of different pathogens to commonly used antimicrobials and detect the risk factors and outcomes of MDR-GNB infections.
Multidrug resistant (MDR) was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories.
We recruited the episodes of bacteremia that occurred between January 2020 and March 2021 in children (aged 0 to 18 y) with hematologic and solid malignancies in the pediatric oncology Department in Ain Shams University Hospital.
The current study conducted a comparison between MDR-GNB and non MDR-GNB infections concerning age, gender, type of malignancy, cancer status, central venous catheter use, length of hospitalization, associated fungal infection, need for ICU admission, indication for ICU admission, and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy. Other variables included associated morbidities, complications.
MDR bacteria were isolated in 18 (16%) samples (17 of which were GNB)
The most commonly detected pathogens with multidrug resistance among the patients included in our study were Klebsiella and Acinetobacter that exhibited multidrug resistance in 11 and 4 samples constituting 61.1% and 22.2% of the whole detected MDR pathogens respectively.
The study revealed that T-cell lymphoblastic lymphoma with p-value = 0.025 and OR 95% CI of 178.639 (1.914 – 16674.106), albumin level ≤ 3.4 with p-value = 0.025 and OR (95% CI) of 9.779 (1.327 – 72.076),; Klebsiella with p-value <0.001 and OR (95% CI) of 32.719 (4.865 – 220.067) and lastly Acinetobacter are associated with MDR infection.
Although being reported by other studies, some variables like ICU admission, prolonged hospital stay, absolute neutrophil count were not associated with MDR in our study.
Antibiotic stewardship, availability of safe blood products and proper infection prevention and control are recommended to prevent the spread of MDR infections among our patients.
CONCLUSION
P
ediatric patients with hematological cancer can experience healthcare-associated infection suspected to be associated with MDR-GNB. This reinforces the need for training about the transmission risks and preventive measures for health professionals (e.g., equipment handling techniques). Contact precautions for all patients with colonization or infection with MDR pathogens and an antibiotic protocol based on local epidemiology should be implemented.
RECOMMENDATIONS
1. Antibiotic Stewardship Programs should be implemented in order to help optimize the use of antibiotic therapy, to increase drug safety, and to avoid antibiotic overuse and consequent antimicrobial resistance. Clinicians should be familiar with treatment strategies for resistant pathogens. Because of the lack of novel agents to treat resistant infections, clinicians must use antibiotics judiciously and appropriately to limit further development of resistance.
2. Infection control and prevention through hand hygiene, air quality, barrier isolation (e.g., the use of gowns, gloves, masks, and eye protection, depending on the type of exposure), endogenous flora suppression by prophylactic antibiotics, and the prevention of device-related infections (e.g., central venous catheters and urinary catheters)
3. Ensure the availability of safe blood products through the development of systems, such as hospital transfusion committees and haemo-vigilance.