Spectrum of microorganisms in febrile neutropenic children with cancer

Objectives To establish an initial effective empirical antibiotic regimen f or febrile neutropenic children with cancer. Patients and Methods Sixty-two children with cancer were admitted at King H ussein Medical Center between Jan. 1996-Jan. 1998 with 80 febrile neutropen ic episodes (absolute neutrophil count (ANC*) < 1000/cmm). Blood culture po sitive patients were analyzed regarding the microorganisms and their antibi otic sensitivity. All patients received first line antibiotics in the form of 3rd generation Cephalosporin (Cefotaxime) and Gentamicin, 2nd line antib iotics (Ceftazidime and Vancomycin) was commenced if fever continued after 48 h then Amphotericin-B was added if fever continued after 96 h. Results Forty-four episodes (55%) were found to have positive blood culture s and 36 (45%) did not grow any organism. Twenty-nine isolates (66%) were g ram-positive which was the commonest isolate (P = 0.05), 11 isolates (25%) were gram-negative and 4 (9%) were Candida albicans. Staph. epidermidis acc ounts for 40% of total isolates. The risks for septicemia were significantl y higher during induction chemotherapy and when the ANC* were below 200/cmm . All gram-positive organisms were sensitive to Vancomycin and all sam-nega tive were sensitive to Amikacin. In the positive culture group antibiotics were changed according to culture sensitivity in 26 (59.1%) and no change i n 18 (40.9%) - (P = 0.24 n.s). In negative culture group, antibiotics were changed because of persisting fever in 10 episodes (27.7%) and no change in 26 (72.3%)- (P = 0.02). Conclusion (1) Gram-positive organisms particularly Staph. epidermidis were the common est isolates in our children. (2) The risk to have septicemia was significantly higher in patients with A NC* < 200/cmm, and in induction phase of chemotherapy. (3) We recommend adding Vancomycin to the regimen of Amikacin and 3rd gener ation Cephalosporins as first line antibiotics for febrile neutropenic chil dren with cancer.