Published: 2018-12-24

A case of pediatric leukemia with multi drug resistant bacterial infections

Saravanan Murugesan, Parthiban Rudrapathy, Sajani Samuel


Infections still remain a major cause of therapy-associated morbidity and mortality in pediatric cases with acute myeloid leukemia (AML). Down syndrome (DS) children have an approximately 10-20 fold higher incidence of acute leukemia and approximately 150 fold increased risk of developing myeloid leukemia of DS (ML-DS).  Multi-drug resistant (MDR-GNB) Gram-negative bacterial septicaemia is an emerging global challenge. Authors are reporting a 4 and half year old boy with diagnosis Acute Megakaryocytic Leukemia (AMKL) who developed septicaemia and diaper rash. MDR E. coli was isolated and he was treated with fosfomycin followed by colistin. The boy developed cardiac arrest with chest compression and expired.


Bacterial infections, Leukemia, Multi-drug resistance

Full Text:



Bochennek K, Hassler A, Perner C, Gilfert J, Schoning S, Klingebiel T, et al. Infectious complications in children with acute myeloid leukemia: decreased mortality in multicenter trial AML-BFM 2004. Blood Cancer J. 2017;6(1):e382.

Whitlock JA. Down syndrome and acute lymphoblastic leukaemia. Br J Haematol. 2006;135(5):595-602.

Jastaniah W, Alsultan A, Al Daama S, Ballourah W, Bayoumy M, Al-Anzi F, et al. Treatment results in children with myeloid leukemia of Down syndrome in Saudi Arabia: A multicenter SAPHOS leukemia group study. Leukemia Res. 2017;58(1):48-54.

Dua V, Yadav SP, Sachdeva A. Should we treat children with Down syndrome and leukemia in the developing world? J Pediatr Hematol Oncol. 2012;29(2):105-8.

Shankar K, Radhakrishnan V, Vijayakumar V, Ramamoorthy J, Ganesan P, Dhanushkodi M, et al. Prevalence of multi‐drug resistant organisms in stool of paediatric patients with acute leukaemia and correlation with blood culture positivity: A single institution experience. Pediatr Blood Cancer. 2018;65(1):e26740.

Zengin E, Sarper N, Gelen SA, Demirsoy U, Karadoğan M, Kılıç SÇ, et al. High Infection-Related Mortality in Pediatric Acute Myeloid Leukemia without Preventive Antibiotics and Antifungals: Retrospective Cohort Study of a Single Center from a Middle-Income Country. Turk J Haematol. 2017;34(4):340.

Verma SP, Dubashi B, Narayanan P, Basu D, Dutta TK, Dhanraj KM. A case of pediatric acute lymphoblastic leukemia with invasive candidiasis: Short Review. Indian Indian J Hematol Blood Transfus. 2014;30(1):101-4.

Ceppi F, Stephens D, den Hollander BS, Krueger J, Whitlock J, Sung L, et al. Clinical presentation and risk factors of serious infections in children with Down syndrome treated for acute lymphoblastic leukemia. Pediatr Blood Cancer. 2016;63(11):1949-53.

Kuo FC, Wang SM, Shen CF, Ma YJ, Ho TS, Chen JS, et al. Bloodstream infections in pediatric patients with acute leukemia: Emphasis on gram-negative bacteria infections. J Microbiol Immunol Infect. 2017;50(4):507-13.

Suppola JP, Volin L, Valtonen VV, Vaara M. Overgrowth of Enterococcus faecium in the feces of patients with hematologic malignancies. Clin Infect Dis. 1996;23(4):694-7.

Raveendranath S, Nair R, Gangadharan SS. Characterization and Antimicrobial Susceptibility Pattern of Clinical Isolates of Enterococci in a Tertiary Care Cancer Hospital, Kerala, India. Int J Curr Microbiol App Sci. 2017;6(2):618-25.