الفهرس 
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Abstract
Patients in Oncology wards are more vulnerable to develop infections. Cancer and chemotherapy predispose these patients to infection leading to disturbances in the treatment regimen, prolonged hospitalization, increased cost of health care, and reduced survival (Bhat et al., 2021).
In children with cancer and febrile neutropenia (FN), bloodstream infection (BSI) is associated with increased mortality, underscoring the need for appropriate diagnostic investigation and early administration of broad-spectrum antibiotics (Gabrielle et al., 2021).
Cytotoxic chemotherapies used in the treatment of malignancies are myelosuppressive and result in variable duration and severity of neutropenia (Barreto et al., 2014).
Patients with hematologic malignancies are at high risk of Gram-negative bacteremia because of chemotherapy-induced gastrointestinal mucositis and prolonged periods of neutropenia. Identification of these pathogens by culture typically takes 2-4 days (Freifeld et al., 2011).
Infection by MDR bacteria is the hall mark and the main cause of death in patients with decreased immunity (Cattanco et al., 2018).
Bacterial colonization is considered the initial step in infection development, followed by translocation of colonizing bacteria. Recurring hospitalization is a major risk factor for colonization by multi-drug-resistant (MDR) bacteria in the gut and subsequent BSI development (Alrstom et al., 2021).
Rising incidence in BSI in pediatric patients with cancer is caused by multi drug resistant (MDR) bacteria, a high prevalence of rectal colonization by MDR and extended-spectrum β-lactamase-producing organisms (ESBLO), and a high conversion rate from sensitive bacteria to resistant strains over time (Averbuch et al., 2013).
The objectives of the present work were to identify the risk factors that predisposed hospitalized patients to MDR infection, to assess the role of rectal swabs in predicting blood infection in pediatric patients with cancer and to screen the most common pathogenic organisms in these patients and the sensitive antibiotics to reduce the risk of infection, reduce the mortality rate and improve the outcome in those patients.
This cross-sectional observational study included 45 newly diagnosed patients with leukemia who underwent initial rectal colonization study and admitted at Ain Shams University, Pediatric Hospital, Hematology Oncology inpatient ward in a period of 6 months starting from May 2022 till December 2022.