Κατεύθυνση Παιδιατρική Λοιμωξιολογία
Library of the School of Health Sciences

2019-03-16

2019

Sfetsiori Angeliki-Eleni

Τσολιά Μαρία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπουσα
Παπαευαγγέλου Βασιλική, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σπυρίδης Νικόλαος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ

Επιδημιολογική, αναδρομική μελέτη των κλινικών και εργαστηριακών χαρακτηριστικών της μικροβιαιμίας σε παιδιά με καρκίνο κατά τη διάρκεια της περιόδου Φεβρουαρίου 2011-Φεβρουαρίου 2018

Greek

Epidemiologic, retrospective study on clinical and laboratory characteristics of blood stream infections in children with cancer from February 2011 to February 2018

BACKROUND
Children with cancer are at increased risk of life-threatening infections such as blood stream infections due to their underlying disease, intensive treatment and the presence of central venous catheters (CVC).
METHODS- AIM
The aim of this retrospective study (February 2011-February 2018) was to evaluate patients’ characteristics, clinical and laboratory findings as well as variables related to treatment and outcome of children with cancer who developed a Blood Stream Infection (BSI). An epidemiological comparison of the results between this study and the previous 7-year period (2003-2010) in the same department was conducted. Moreover, possible differences not only in univariate but also in multivariate analysis were analyzed in the following subgroups: patients with heamatologic malignancy vs patients with solid tumors, ALL patients vs AML patients, monomicrobial vs polymicrobial bacteremia, Gram- vs Gram+ bacteremia as well as inpatient vs outpatient BSI.
RESULTS
Two hundred fifty-nine BSI episodes were recorded in 162 children with cancer (1.6 per patient). Sixty-three children experienced more than one episodes whereas 30 episodes were polymicrobial. Among the 229 monomicrobial BSI episodes 224 bacteraemias (Gram-:49.1%, Gram+: 50.9%) and 5 fungaemias were recorded. The most common isolated organisms were: Staphylococcus coagulase negative (66 episodes), Esherichia coli (33 episodes), Pseudomonas sp. (31 episodes), Klebsiella sp. (20 episodes) and Staphylococcus aureus (17 episodes). In 67% episodes the patients were neutropenic, whereas in 91% children had CVC in place. Neutropenia and CVC at the same time were recorded in 62% of episodes. Complications (catheter removal, septic shock, ARDS) were noted in 50/259 (19.3%) episodes whereas 2 deaths attributed to infection were recorded. In the subanalysis we found that patients with hematologic malignancy and BSI were more frequently neutropenic (p=0.000) and experienced more than one BSI episodes (p=0.028) compared to patients with solid tumors. Moreover, ALL patients with BSI compared to AML patients were more frequently treated with corticosteroids (p=0.021) and on the other side less frequently transfused (p=0.006). Gram- bacteremia was more common among girls (p=0.003), children with haematologic malignancies (p=0.001) and patients with higher CRP (p=0.026). No differences between polymicrobial and monomicrobial BSI episodes were found. Hospitalized patients with BSI compared to non-hospitalized patients had a higher rate of comorbidities (p=0.027), recent surgery (p=0.000), procedures (p=0.025) and antibiotic treatment (p=0.000). Finally, no significant differences compared to the epidemiologic study of the previous 7-year period in the same department were detected.
CONCLUSIONS
In the recent 15 years the characteristics of blood stream infections in children with cancer have remained the same. Gram- and Gram+ BSIs occur at the same frequency, the incidence of fungaemia is low and polymicrobial BSI is not rare. BSIs often occur not rarely in non-neutropenic patients and are more commonly due to Gram+ bacteria whereas in neutropenic patients Gram- bacteremia is more frequently observed. Three out of 4 cancer patients with BSI suffer from haematologic malignancy. In one out of 5 BSI episodes complications are present, whereas the low mortality of children with cancer and BSI is promising (0.7%).

Health Sciences

Children, Cancer, Blood stream infections, Bacteraemia, Infection

No

0

Yes

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94

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https://pergamos.lib.uoa.gr/uoa/dl/object/2866261