Outcome of sepsis due to multidrug-resistant bacterial sepsis in a paediatric oncology unit in India: An eight-year retrospective analysis

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Abstract Background Multidrug-resistant organisms (MDRO) cause significant morbidity and mortality in hospitalised patients. This is particularly true in paediatric oncology units, especially in low- and middle-income countries with high prevalence of MDRO, like India. We present outcomes of children on cancer chemotherapy diagnosed with MDRO sepsis in our centre. Methods Retrospective chart review of all children with blood culture-proven MDRO sepsis diagnosed between October 2017 and August 2025 was performed. Before 2021, MDRO-GNB (Gram-negative bacilli) sepsis were treated with Colistin + Meropenem combination. From the year 2021, they were treated with Colistin ± ceftazidime-avibactam ± Aztreonam ± Tigecycline combination. Results During the study period, 574 children on cancer chemotherapy had a total of 1886 febrile episodes. Of these, 324 episodes were blood culture-positive sepsis (Gram positive cocci (GPC) -130 (40%), GNB – 171 (52.77%), Fungi – 21 (6.5%). Among the 171 gram-negative bacterial sepsis, 64 were MDRO (37.42%), including 35 multidrug resistant, 28 extreme-drug resistant, and 1 pan-drug resistant organisms. The most common GNB-MDRO were Klebsiella pneumoniae (n=24, 37.5%) followed by Escherichia Coli (n=19, 29.7%), and non-fermenting GNB (n=19, 29.7%). Antibiotic sensitivity of GNB is depicted in Table 1. 43 (67.2%) had hemodynamic instability, 32 (50%) required intensive care (ICU), with 30 (46.87%) requiring inotropic support and 26 (40.62%) requiring respiratory support. Nearly a third i.e., 22 (34.37%) developed multi-organ dysfunction (MODS), and a quarter, 17 (26.56%) succumbed to MODS. On comparing outcomes before and after 2021, no significant difference was noted in the need for ICU care (50%, 50%), proportion of MODS (32% vs 42.8%, p=0.45), and proportion of mortality (28% vs 21.42%, p = 0.62) Among the 130 episodes of GPC sepsis, 86 (66.15%) were coagulase-negative staphylococcus (CONS), 16 (12.3%) were staphylococcus aureus, 11 (8.5%) were enterococcus, 17 (13%) were others. Nearly two-thirds of CONS i.e., 52 (60.5%) and half of staphylococcus aureus i.e., 7 (43.75%) were methicillin-resistant. 7 (63.6%) of enterococcus infections were vancomycin resistant. Among those with MDRO-GPC, 25 (37.87%) required intensive care, 20 (30.3%) required inotropes, and 17 (25.75%) required mechanical ventilation. 8 (12.12%) developed MODS, and all 8 (12.12%) succumbed. Conclusion MDRO contributes significantly to morbidity and mortality in paediatric oncology units. Nearly half of those with MDRO-GNB & a third of those with GPC-MDRO require intensive care, with 26% and 12% mortality, respectively. Use of ceftazidime/avibactam & colistin combination has not shown to have a survival benefit. Larger sample size is required to confirm these findings.