Gram-negative Blood-stream Infections and Emerging Antimicrobial resistance (AMR) in Children with Acute Myeloid Leukemia during Induction Chemotherapy at Children's Cancer Hospital Egypt 57357

Grace Mbatia¹Reham Khedr^2,3*Leslie Lehmann⁴Mervat El Anany⁵Khaled Alsheshtawi⁵Omayma Hassanain⁵Sonia Mahmoud⁵Omneya Hassanain⁵Lobna Shalaby⁵Alaa Elhaddad⁵

• ¹Aga Khan University Hospital, Nairobi, Nairobi, Kenya
• ²pediatric Oncology, Children’s Cancer Hospital (Egypt), Zenab, Egypt
• ³Department of Pediatrics Oncology, National Cancer Institute, Cairo University, Giza, Beni Suef, Egypt
• ⁴Harvard Medical School, Boston, Massachusetts, United States
• ⁵Children’s Cancer Hospital (Egypt), Zenab, Egypt

In children receiving therapy for acute myeloid leukemia (AML), gram-negative bacteremia is associated with significant morbidity and mortality, especially in the presence of multi-drug resistant [MDR] organisms. The purpose of this study was to determine the prevalence and antibiotic susceptibility patterns of gram-negative bloodstream infections [GNBSI]] during the period of induction chemotherapy [IC] and the associated morbidity and mortality in a large pediatric oncology hospital in a low-middle-income country (LMIC). We reviewed microbiological data for 328 consecutive children admitted for AML IC and identified 90[27.4%] children with at least one GNBSI during induction, 72/90[80%] of whom had at least one MDR GNBSI. 124 GNBSI episodes were identified among the ninety children: E.coli 54.8%, K.pneumoniae 16.9%, A.baumannii 6.5%, E.cloacae 4.8%, and P.aeruginosa 4.0%.Thirty-day cumulative infection-related mortality was 27.8% [18.9-37.3%]. Associated morbidity included typhlitis [29/90 (32.2%)], sepsis-related central venous catheter [CVC] removal [12/90 (13.3%)], and admission to intensive care unit [38/90(42%)]. Conclusion: Our study highlights the prevalence of gram-negative bacteria among febrile neutropenic children with AML and the high incidence of antibiotic resistance in our hospital. There is a need for keen surveillance globally of the epidemiology of multi-drug resistant gram-negative organisms and thoughtful studies into antibiotic stewardship to reduce the growing threat of MDR GN infections and the associated morbidity and mortality.