Trends in infections in children with malignant disease in 2000: comparison of data of 1980/81

Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients

OBJECTIVES

A knowledge of current epidemiology and resistance patterns is crucial to the choice of empirical treatment for bacteraemias in haematology and cancer patients.

METHODS

A literature review on bacteraemias in cancer patients considered papers published between January 1st 2005 and July 6th 2011. Additionally, in 2011, a questionnaire on the aetiology and resistance in bacteraemias, and empirical treatment, was sent to participants of the European Conference on Infections in Leukemia (ECIL) meetings; recipients were from 80 haematology centres.

RESULTS

For the literature review, data from 49 manuscripts were analysed. The questionnaire obtained responses from 39 centres in 18 countries. Compared with the published data, the questionnaire reported more recent data, and showed a reduction of the Gram-positive to Gram-negative ratio (55%:45% vs. 60%:40%), increased rates of enterococci (8% vs. 5%) and Enterobacteriaceae (30% vs. 24%), a decreased rate of Pseudomonas aeruginosa (5% vs. 10%), and lower resistance rates for all bacteria. Nevertheless the median rates of ESBL-producers (15-24%), aminoglycoside-resistant Gram-negatives (5-14%) and carbapenem-resistant P. aeruginosa (5-14%) were substantial, and significantly higher in South-East vs. North-West Europe.

CONCLUSIONS

The published epidemiological data on bacteraemias in haematology are scanty and mostly dated. Important differences in aetiology and resistance exist among centres. Updated analyses of the local epidemiology are mandatory to support appropriate empirical therapy.

Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

BACKGROUND

pediatric hematology/oncology patients are faced with an increased risk of nosocomial infections (NIs) that vary in different populations and different institutions with considerable morbidity and mortality. This study was undertaken to assess the frequency and patterns of NIs in 1564 pediatric patients and to determine the prevalence of causative organisms and their antimicrobial sensitivity.

METHODS

a retrospective analysis was made in the patients admitted between January 2007 and January 2008 to the pediatric hematoloy/oncology unit of Mansoura University, Egypt. The 1564 patients showed 2084 admissions and 27 092 inpatient days. The Centers for Disease Control and Prevention criteria were used as a standard definition for NI.

RESULTS

the overall rate of NIs in all patients and neutropenic patients was 8.6 and 25.3 per 1000 patient-days respectively. The frequent sites of NIs were blood stream (42.7%), the respiratory system (25.3%), the urinary system (22.2%) and the central nervous system (9.8%), whereas nosocomial fever of unknown origin constituted 52.9% of cases. The incidence of NIs was significantly higher during neutropenic days (P<0.001). Gram-positive organisms represented 64.5% of pathogens (Staphylococci 71.5%, Streptococci 16%, and pneumococci 7%), and Gram-negative organisms represented 30% (E. coli 48.6%, Klebsiella 15.7%, Pseudomonas 35.7%, and C. albicans 5.5%). Positive cultures were more frequent in summer (July to September). Susceptibility of isolated organisms was relatively low (cefoperazone/sulbactam 49.9%, amikacin 35.9%, imipenem/cilastin 34.4%, cefoperazone 33.6%, and vancomycin 36.5%). Methicillin-resistant S. aureus, extended spectrum beta lactamase and vancomycin resistant enterococci represented 30%, 45% and 75% of isolated S. aureus, Gram-negative organisms and Enterococci, respectively.

CONCLUSIONS

blood stream infection and fever of unknown origin are the most common nosocomial infections in pediatric hematology/oncology patients with a higher risk during neutropenic days. Isolated organisms are multi-drug resistant, predominantly Gram-positive pathogens with a high incidence of methicillin-resistant S. aureus, extended spectrum beta lactamase and vancomycin resistant enterococci organisms.

Procalcitonin as an early marker of bacterial infection in neutropenic febrile children with acute lymphoblastic leukemia

OBJECTIVE AND DESIGN

The aim of this study was to assess the value of procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-a), interleukin (IL)-1b, IL-8, and soluble TNF receptor II (sTNFRII) in early and rapid diagnosis of infection in neutropenic children with acute lymphoblastic leukemia (ALL) and to distinguish bacterial from viral infections.

PATIENTS

The study included five groups (A, B, C, D, and E) of children with ALL undergoing intensive chemotherapy. Groups A and B consisted of neutropenic children with bacterial and viral infection, respectively. Groups C and D consisted of nonneutropenic children with bacterial and viral infection, respectively. Group E consisted of children without neutropenia and without fever.

METHODS

In all groups, blood samples were collected upon admission and then for 7 days on a daily basis. Levels of CRP, PCT, TNF-a, IL-1b, IL-8, and sTNFRII were determined in all blood samples.

RESULTS

We found a highly significant difference in PCT levels between bacterial and nonbacterial episodes. Sensitivity and specificity of PCT were 94 and 96.5%, respectively.

CONCLUSIONS

Serial measurement of PCT levels on a daily basis seems to be helpful for early prediction of severe bacterial infections, monitoring febrile episodes regarding response to antibiotic therapy, and early detection of complications in the infectious process.

Infection-related mortality in children with malignancy in England and Wales, 2003-2005

BACKGROUND

Infections are an important component of treatment-related mortality in children with malignancy. Infection-related mortality is potentially preventable and it is important to identify areas where prevention and treatment can be improved such as through vaccination, early diagnosis and aggressive management. The aim of this study is to describe the infections contributing to deaths in children under 15 years with malignancy in England and Wales in the period 2003-2005.

PROCEDURE

Analysis of death certificate data of children under 15 years in England and Wales from 2003-2005 identified all patients with pre-selected ICD-10 codes relating to haematological malignancy or solid tumours and an infectious disease as the main or underlying cause of death.

RESULTS

There were 82 infection-related deaths contributing to approximately 25% of all deaths from haematological malignancy and 5% of all deaths from solid tumours during 2003-2005. This included 15 relapsed patients (18%), 5 haematopoietic stem cell transplant patients (6%) and 4 patients with Down's syndrome (5%). Organisms were documented in 44 deaths (54%). Seventeen infections (21%) were fungal of which 12 (15%) were Aspergillus; 17 (21%) were bacterial, including 9 (11%) Gram-negative isolates. There were 10 (12%) infection-related deaths where viruses were identified of which three deaths were from respiratory syncytial virus (RSV).

CONCLUSIONS

This study shows that infections still make an important contribution to deaths amongst children with malignancy. Effective prevention strategies need to be identified and strengthened.