Multi-drug Resistant Organisms in Stool Culture and Its Relationship with Morbidity and Mortality in Pediatric Patients with Acute Leukemia

Background: Enteric colonization with multidrug-resistant organisms (MDRO) in acute leukemic pediatric patients may constitute a major risk for serious infections as bloodstream infections (BSI), particularly during periods of neutropenia, and contribute significantly to increased morbidity and mortality.
Objective: To assess the frequency of MDRO isolation from stool cultures of pediatric patients with acute leukemia and its relationship with blood culture positivity and mortality.
Patients and Methods: The study involved analysis of pediatric patients with newly diagnosed acute leukemia less than 18 years of age from January 2019 to June 2019 in Zagazig University Hospital, a total of 60 patients were included in this study.  Stool cultures were sent within 48 hours of hospital admission and blood cultures were sent when clinically indicated. Isolates were identified by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis. Antimicrobial susceptibility was tested using VITEK-2. The survival rate for all patients was followed up for 60 days.
Results: Blood culture results were positive in a significantly higher ratio of patients with positive stool culture (36.1%) compared to those with negative stool culture (12.5%) (P=0.043). Enterococcus faecalis and Escherichia coli (E. coli) were the most frequently isolated MDRO from positive stool cultures (40% and 31%, respectively), while E. coli was the most frequent MDRO isolated from blood (50%). MDRO were isolated from stool cultures of 32 patients with a frequency of (53.8 %). Among patients with positive stool and blood cultures, mortality was significantly higher (P < 0.029) among those with MDRO isolated from both cultures compared to those isolating non-MDRO (85.7% vs 16.7%).   
Conclusion: Newly diagnosed children with acute leukemia have a high frequency of enteric colonization by MDRO, which is significantly associated with increased positivity of blood cultures and mortality.