THE CHANGING EPIDEMIOLOGY OF BACTEREMIA IN NEUTROPENIC CHILDREN WITH CANCER

Gram-positive bacteria have been the predominant organisms causing bac teremia in febrile neutropenic cancer patients during the past decade. Recently we have noted an increase in Gram-negative bacteremia in chi ldren and adolescents with cancer. Therefore we retrospectively review ed 153 episodes of bacteremia during a 6-year period to investigate ch anges in the etiology of bacteremia in pediatric oncology patients. In the early 3-year period (January, 1988, to December, 1990) Gram-posit ive organisms comprised 73 (74%) of the 99 isolates, and Staphylococcu s epidermidis was the most common isolate. In the later 3-year period (January, 1991, to December, 1993) Gram-negative organisms were seen w ith greater frequency and represented 50% of isolates (P = 0.004). Pse udomonas aeruginosa was the most commonly isolated organism during thi s period (22% of all isolates). We speculate that the recent utilizati on of more intensive chemotherapy regimens has caused an alteration in the epidemiology of bacteremia in children and adolescents with cance r which could influence the initial empiric antibiotic regimens and th e outcome of such infections.