Fluoroquinolone Susceptibility and Comparative Outcomes of Gram-negative Bloodstream Infection in Pediatric Patients with Hematologic Malignancy

Strategic Insights -

A new study from the Children's Hospital of Philadelphia has shed light on the impact of fluoroquinolone non-susceptible (FQN-NS) gram-negative (GN) bloodstream infections (BSI) on outcomes in pediatric patients with hematologic malignancies. Researchers found that FQN-NS BSI was associated with higher 30-day all-cause mortality and sepsis-related mortality, although the association was not statistically significant. The study suggests that the impact of FQN-NS on outcomes may be mediated through resistance to empiric therapy, which is associated with worse outcomes.

Key Takeaways:

  • The study used a single-center cohort of pediatric patients with hematologic malignancies and neutropenia-associated GN BSI between 2014 and 2023, with a total of 119 GN BSI events.
  • Among the GN BSI events, 82 (68.9%) were FQN-susceptible and 37 (31.1%) were FQN-non-susceptible.
  • In IPTW-adjusted analyses, FQN-NS BSI was associated with higher 30-day all-cause mortality (aRR: 2.62, 95% CI: 0.39-17.64) and sepsis-related mortality (aRR: 2.60, 95% CI: 0.16-41.65).
  • The study found that effect modification by empiric therapy may have contributed to the association between FQN-NS and poor outcomes, suggesting that FQN-NS itself may not directly drive poor outcomes, but its impact appears mediated through resistance to empiric therapy.
  • The study has implications for the treatment of pediatric patients with hematologic malignancies, highlighting the need forvigilance in monitoring antibiotic resistance and the importance of empiric therapy.
  • The study's findings may also inform guidelines for the use of fluoroquinolone prophylaxis in pediatric patients with hematologic malignancies.

Statistics:

  • 119 GN BSI events were analyzed in the study.
  • 68.9% of GN BSI events were FQN-susceptible, while 31.1% were FQN-non-susceptible.
  • FQN-NS BSI was associated with higher 30-day all-cause mortality (aRR: 2.62, 95% CI: 0.39-17.64).
  • FQN-NS BSI was also associated with higher sepsis-related mortality (aRR: 2.60, 95% CI: 0.16-41.65).

Sources:

  • NewsRx. Reports Outline Neutropenia Study Findings from Children's Hospital of Philadelphia (Fluoroquinolone Susceptibility and Comparative Outcomes of Gram-negative Bloodstream Infection in Pediatric Patients with Hematologic Malignancy). Hematology Week. October 13, 2025; p 481.
  • Journal of the Pediatric Infectious Diseases Society. Fluoroquinolone Susceptibility and Comparative Outcomes of Gram-negative Bloodstream Infection in Pediatric Patients with Hematologic Malignancy. 2025.