Prevalence of multi-resistant bacteria associated with febrile neutropenia in pediatric oncology patients

Abstract

Introduction: Antimicrobial resistance (AMR), particularly that associated with extended-spectrum beta-lactamase (ESBL)-producing and carbapenemase-producing bacteria, represents a critical global public health threat. Febrile neutropenia is a frequent and potentially life-threatening complication in cancer patients undergoing chemotherapy; in the pediatric population, it is of particular concern given its significant impact on morbidity and mortality. This study aimed to determine the prevalence of multidrug-resistant (MDR) bacteria associated with febrile neutropenia, with the purpose of informing the revision and updating of institutional empirical antibiotic therapy protocols. Methodology: An observational, descriptive, cross-sectional, and retrospective study was conducted at the Baca Ortiz Pediatric Hospital in Quito, Ecuador. All eligible records were analyzed, constituting a census of 184 pediatric oncology patients with at least one episode of febrile neutropenia and a positive blood culture between 2019 and 2023. Inclusion criteria were temperature ?38 °C and an absolute neutrophil count (ANC) ?500/mm³. Results: Female patients accounted for 51.6% of the study population. Leukemia was the predominant oncologic diagnosis (84.8%), and more than 90% of patients presented severe neutropenia, concentrated primarily within this diagnostic group. Gram-negative bacteria predominated: Klebsiella pneumoniae (16.8%) and Escherichia coli (16.3%) were the most prevalent Enterobacteriaceae, and Pseudomonas aeruginosa (7.6%), the most frequent non-fermenting Gram-negative bacillus. Resistance analysis was performed on 160 bacterial isolates, after excluding 24 fungal isolates. The prevalence of ESBL-producing bacteria was 16.0% (95% CI: 10.0%–22.0%), and that of carbapenemase-producing bacteria was 8.0% (95% CI: 3.0%–12.0%). Conclusion: Multidrug-resistant Gram-negative bacteria predominated in pediatric oncology patients with febrile neutropenia, with an ESBL prevalence of 16.0% and a carbapenemase prevalence of 8.0% among bacterial isolates. These findings may contribute to the review and updating of institutional empirical antibiotic therapy protocols for this patient population and a critical determination for the optimization of empirical treatment strategies in this group.