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Gao S, Albu E, Tuand K, Cossey V, Rademakers F, Van Calster B, Wynants L. Systematic review finds risk of bias and applicability concerns for models predicting central line-associated bloodstream infection. J Clin Epidemiol 2023; 161:127-139. [PMID: 37536503 DOI: 10.1016/j.jclinepi.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES To systematically review the risk of bias and applicability of published prediction models for risk of central line-associated bloodstream infection (CLA-BSI) in hospitalized patients. STUDY DESIGN AND SETTING Systematic review of literature in PubMed, Embase, Web of Science Core Collection, and Scopus up to July 10, 2023. Two authors independently appraised risk models using CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and assessed their risk of bias and applicability using Prediction model Risk Of Bias ASsessment Tool (PROBAST). RESULTS Sixteen studies were included, describing 37 models. When studies presented multiple algorithms, we focused on the model that was selected as the best by the study authors. Eventually we appraised 19 models, among which 15 were regression models and four machine learning models. All models were at a high risk of bias, primarily due to inappropriate proxy outcomes, predictors that are unavailable at prediction time in clinical practice, inadequate sample size, negligence of missing data, lack of model validation, and absence of calibration assessment. 18 out of 19 models had a high concern for applicability, one model had unclear concern for applicability due to incomplete reporting. CONCLUSION We did not identify a prediction model of potential clinical use. There is a pressing need to develop an applicable model for CLA-BSI.
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Affiliation(s)
- Shan Gao
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Elena Albu
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Krizia Tuand
- 2Bergen - Learning Centre Désiré Collen, KU Leuven Libraries, KU Leuven, Leuven, Belgium
| | - Veerle Cossey
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Infection Control and Prevention, University Hospitals Leuven, Leuven, Belgium
| | | | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; EPI-Center, KU Leuven, Leuven, Belgium.
| | - Laure Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; EPI-Center, KU Leuven, Leuven, Belgium; Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Incidence and Causative Organisms of Bacteriuria in Children With Cancer: A 9-Year Experience in a Tertiary Pediatric Center. J Pediatr Hematol Oncol 2023; 45:21-24. [PMID: 35972935 DOI: 10.1097/mph.0000000000002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/13/2022] [Indexed: 02/03/2023]
Abstract
Although infection is common in patients with cancer, the distribution of causative agents and the proportion of resistant bacteria in patients with urinary tract infection remain unknown. The aim of this study was to describe the incidence, the causative agents, and the proportion of antimicrobial resistance in bacteria cultured from urine of hospitalized children with cancer. A single-center retrospective chart review of patients with cancer admitted between 2012 and 2020 was performed to identify patients with positive urine culture. Overall, 61 (0.9%) of 7107 patients were identified to have positive urine cultures. Among them, 25 patients (41%) had symptomatic bacteriuria. The most common pathogenic bacterium among all patients was Escherichia coli ( E. coli ) (n=15, 25%), followed by Enterococcus sp. (n=14, 23%), Klebsiella sp. (n=12, 20%), and Pseudomonas aeruginosa ( P. aeruginosa ) (n=12, 20%). Extended spectrum β-lactamases-producing E. coli and Extended spectrum β-lactamases-producing Klebsiella pneumoniae were detected in 1 patient (2%) and 4 patients (7%), respectively. No multidrug-resistant P. aeruginosa and vancomycin-resistant Enterococcus were detected. The incidence of bacteriuria was found to be low in children with cancer. The distribution of causative agents of bacteriuria in children with solid tumors and hematologic diseases may be different from that in previously healthy children.
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Predictive Factors for Gram-negative Versus Gram-positive Bloodstream Infections in Children With Cancer. J Pediatr Hematol Oncol 2022; 44:e368-e373. [PMID: 34310469 DOI: 10.1097/mph.0000000000002253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identifying potential predictive factors for the type of bacteremia (Gram-negative vs. Gram-positive) in children with cancer would be crucial for the timely selection of the appropriate empiric antibiotic treatment. MATERIALS AND METHODS Demographic, clinical, and laboratory characteristics of children with cancer and a bacterial bloodstream infection (BSI) (February 1, 2011 to February 28, 2018) in a tertiary pediatric oncology department were retrospectively examined and were correlated with the type of isolated bacteria. RESULTS Among 224 monomicrobial bacterial BSI episodes, Gram-negative and Gram-positive bacteria were isolated in 110 and 114 episodes, respectively. Gram-negative bacteria were isolated significantly more frequently in girls (Gram-negative/Gram-positive ratio 1.7:1) versus boys (Gram-negative/Gram-positive ratio 0.72:1), P=0.002, in patients with previous BSI episodes (1.4:1) versus those without (0.8:1), P=0.042, and in children with hematologic malignancy (1.3:1) versus those who suffered from solid tumors (0.52:1), P=0.003. Gram-negative BSI episodes were more frequently correlated with a lower count of leukocytes, P=0.009, neutrophils, P=0.009 and platelets, P=0.002, but with significantly higher C-reactive protein (CRP) levels, P=0.049. Female sex, hematologic malignancy, and higher CRP levels remained independent risk factors for Gram-negative BSI in the multivariate analysis. Among neutropenic patients, boys with solid tumors and a recent central venous catheter placement appear to be at increased risk for Gram-positive BSI in the multivariate analysis. CONCLUSIONS Although Gram-negative and Gram-positive BSIs are close to balance in children with cancer, Gram-negative bacteria are more likely to be isolated in girls, children with hematologic malignancies and those with higher CRP level at admission. In contrast, neutropenic boys with solid tumors and a recently placed central venous catheter may be at increased risk for Gram-positive BSI indicating probably the need for initially adding antibiotics targeting Gram-positive bacteria.
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Identifying acute lymphoblastic leukemia mimicking juvenile idiopathic arthritis in children. PLoS One 2020; 15:e0237530. [PMID: 32780759 PMCID: PMC7418991 DOI: 10.1371/journal.pone.0237530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Acute lymphoblastic leukemia (ALL) may present with arthritis implying the risk of being misdiagnosed as juvenile idiopathic arthritis (JIA). The aim of this study was to identify predictors for ALL based on clinical and laboratory information. Methods This cross-sectional, retrospective study compared clinical presentation and laboratory results of 26 children with ALL and arthritis versus 485 children with JIA (433 non-systemic, 52 systemic JIA). Using a Bayesian score approach the findings were evaluated by calculating odds ratios (OR) and lnOR as a measure of diagnostic weight. Results Distinction on clinical grounds was difficult, as even a high number of joints involved did not exclude ALL. One or more hematologic cell counts were low (Hb <10 g/dL, platelet count <100 x 109/L, neutrophil count < 1.0 x 109/L) in 92% with ALL, 25% with systemic JIA and 10% with non-systemic JIA. Neutropenia and thrombocytopenia had the highest ORs of 128 (95% CI 43–387) and 129 (95% CI 26–638), each giving a diagnostic weight of 4. The estimated risks of ALL were 0.2% with normal cell counts and 9%, 67% and 100% when one, two or three cell lines were affected. Conclusion A simple count of cell lines with low counts can serve as a basic diagnostic strategy. Children with tri- or bilinear involvement should be referred to a bone marrow, and those with unilinear involvement a thorough screen for further evidence of ALL (organomegaly, ESR, LDH, uric acid, and blood smear).
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5
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Kara SS, Tezer H, Polat M, Cura Yayla BC, Bedir Demirdağ T, Okur A, Fettah A, Kanık Yüksek S, Tapısız A, Kaya Z, Özbek N, Yenicesu İ, Yaralı N, Koçak Ü. Risk factors for bacteremia in children with febrile neutropenia. Turk J Med Sci 2019; 49:1198-1205. [PMID: 31385488 PMCID: PMC7018307 DOI: 10.3906/sag-1901-90] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background/aim Bacteremia remains an important cause of morbidity and mortality during febrile neutropenia (FN) episodes. We aimed to define the risk factors for bacteremia in febrile neutropenic children with hemato-oncological malignancies. Materials and methods The records of 150 patients aged ≤18 years who developed FN in hematology and oncology clinics were retrospectively evaluated. Patients with bacteremia were compared to patients with negative blood cultures. Results The mean age of the patients was 7.5 ± 4.8 years. Leukemia was more prevalent than solid tumors (61.3% vs. 38.7%). Bacteremia was present in 23.3% of the patients. Coagulase-negative staphylococci were the most frequently isolated microorganism. Leukopenia, severe neutropenia, positive peripheral blood and central line cultures during the previous 3 months, presence of a central line, previous FN episode(s), hypotension, tachycardia, and tachypnea were found to be risk factors for bacteremia. Positive central line cultures during the previous 3 months and presence of previous FN episode(s) were shown to increase bacteremia risk by 2.4-fold and 2.5-fold, respectively. Conclusion Presence of a bacterial growth in central line cultures during the previous 3 months and presence of any previous FN episode(s) were shown to increase bacteremia risk by 2.4-fold and 2.5-fold, respectively. These factors can predict bacteremia in children with FN.
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Affiliation(s)
- Soner Sertan Kara
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Meltem Polat
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Burcu Ceylan Cura Yayla
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Tuğba Bedir Demirdağ
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Arzu Okur
- Department of Pediatric Oncology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ali Fettah
- Department of Pediatric Hematology-Oncology, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey
| | - Saliha Kanık Yüksek
- Department of Pediatric Infectious Diseases, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey
| | - Anıl Tapısız
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zühre Kaya
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Namık Özbek
- Department of Pediatric Hematology-Oncology, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey
| | - İdil Yenicesu
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Neşe Yaralı
- Department of Pediatric Hematology-Oncology, Ankara Hematology Oncology Children’s Training and Research Hospital, Ankara, Turkey
| | - Ülker Koçak
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Chaber R, Latos-Grażyńska E, Ciebiera K, Łach K, Tokar B, Cebulski J, Trybucka K, Mazur A. Body Mass Index (BMI) and Infectious/Febrile Episodes in Children with Intermediate Risk Acute Lymphoblastic Leukemia (IR ALL). Nutr Cancer 2018; 71:701-707. [PMID: 30407874 DOI: 10.1080/01635581.2018.1516792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The incidence of treatment related mortality in children with acute lymphoblastic leukemia (ALL) is reported to be between 2% and 4% with infections being the leading cause. AIM To establish a relationship between body mass index at diagnosis (BMI 0), after protocol I therapy completion (BMI I) and the incidence rate ratio (IRR) of infectious/febrile episodes in children with ALL intermediate risk. METHODS Thirty one consecutive patients (2-18 years old, with a male to female ratio of 19/12) with newly diagnosed ALL that were treated uniformly according to ALL IC 2009 protocol were included in this analysis. RESULTS A BMI decrease of at least 5% during protocol I therapy and BMI 1 under 15th percentile score corresponds significantly with higher IRR (with P-values 0.04 and 0.006 respectively) during the whole intensive therapy. CONCLUSION Some relationships between BMI reduction and higher IRR in ALL patients were found, but their significance is limited by the size of the group analyzed.
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Affiliation(s)
- Radosław Chaber
- a Clinic of Paediatric Oncology and Haematology, Faculty of Medicine , University of Rzeszow , Rzeszow , Poland
| | - Elżbieta Latos-Grażyńska
- b Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology , Wroclaw Medical University , Wroclaw , Poland
| | | | - Kornelia Łach
- a Clinic of Paediatric Oncology and Haematology, Faculty of Medicine , University of Rzeszow , Rzeszow , Poland
| | - Barbara Tokar
- b Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology , Wroclaw Medical University , Wroclaw , Poland
| | - Józef Cebulski
- d Center for Innovation and Transfer of Natural Sciences and Engineering Knowledge, University of Rzeszow , Rzeszow , Poland
| | - Katarzyna Trybucka
- a Clinic of Paediatric Oncology and Haematology, Faculty of Medicine , University of Rzeszow , Rzeszow , Poland
| | - Artur Mazur
- e Clinic of Paediatric Endocrinology, Faculty of Medicine , University of Rzeszow , Rzeszow , Poland
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Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children-a systematic review. Eur J Pediatr 2018; 177:337-344. [PMID: 29387980 DOI: 10.1007/s00431-018-3098-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/19/2017] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED It is not clear if children with high fever are at increased risk for serious bacterial infection (SBI). Our aim was to systematically review if children suffering from high fever are at high risk for SBI. Our data sources were Embase, Medline, and Pubmed; from their inception until the last week of March 2017. The study selection were of cohort and case control studies comparing the incidence of SBI in children with hyperpyrexia with children with fever of 41 °C or less, and children with a temperature higher than 40 °C, with children with fever of 40 °C or less. Two reviewers independently pooled studies for detailed review using a structured data-collection form. We calculated the odds ratio and 95% confidence intervals (CI) for SBI, assuming a random-effects model. A sub-group analysis was conducted. In our results, 11 studies met the inclusion criteria. Two studies showed that children with hyperpyrexia are at higher risk for SBI (OR 1.96 95% CI 1.3-1.97). An increased risk for SBI in children with high fever (OR 3.21 95% CI 1.67; 6.22). SBI in infants with temperature over 40 °C was higher compared to infants with lower degree of fever (OR 6.3 95% CI 4.44; 8.95). On older children, the risk for SBI was only slightly higher in children with fever above 40 °C. The limitation of the study is the small amount of studies and that the heterogeneity of the studies was very high. CONCLUSION Young infants with temperature higher than 400 °C are at increased risk for SBI. Risk of SBI in older children with temperature > 400C is minimal. What is known: • An association between high fever and increased risk for SBI was reported in young infants. • Based on only two studies from the 1970s and 1980s, hyperpyrexia is associated with increased risk for SBI. What is new: • Infants under the age of 3 months with fever > 40 °C were found to have increased risk for SBI. • Risk of SBI in older children with temperature > 40 °C is minimal.
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8
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Li MJ, Chang HH, Yang YL, Lu MY, Shao PL, Fu CM, Chou AK, Liu YL, Lin KH, Huang LM, Lin DT, Jou ST. Infectious complications in children with acute lymphoblastic leukemia treated with the Taiwan Pediatric Oncology Group protocol: A 16-year tertiary single-institution experience. Pediatr Blood Cancer 2017; 64. [PMID: 28371256 DOI: 10.1002/pbc.26535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/07/2017] [Accepted: 02/16/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infection is a major complication in pediatric patients with acute lymphoblastic leukemia during chemotherapy. In this study, the infection characteristics were determined and risk factors analyzed based on the Taiwan Pediatric Oncology Group (TPOG) acute lymphoblastic leukemia (ALL) protocol. PROCEDURE We retrospectively reviewed fever events during chemotherapy in 252 patients treated during two consecutive clinical trials at a single institution between 1997 and 2012. Patients were classified as standard, high, and very high risk by treatment regimen according to the TPOG definitions. We analyzed the characteristics and risk factors for infection. RESULTS Fever occurred in 219 patients (86.9%) with a mean of 2.74 episodes per person. The fever events comprised 64% febrile neutropenia, 39% clinically documented infections, and 44% microbiologically documented infections. The microbiologically documented infections were mostly noted during the induction phase and increased in very high risk patients (89 vs. 24% and 46% in standard-risk and high-risk patients, respectively). Younger age and higher risk (high-risk and very high risk groups) were risk factors for fever and microbiologic and bloodstream infections. Female gender and obesity were additive risk factors for urinary tract infection (odds ratios = 3.52 and 3.24, P < 0.001 and P = 0.004, respectively). CONCLUSIONS Infections developed primarily during the induction phase, for which younger age and higher risk by treatment regimen were risk factors. Female gender and obesity were additive risk factors for urinary tract infection.
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Affiliation(s)
- Meng-Ju Li
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Hao Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yung-Li Yang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Yao Lu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Lan Shao
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - An-Kuo Chou
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yen-Lin Liu
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kai-Hsin Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Dong-Tsamn Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shiann-Tarng Jou
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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The Effects of Hospital Length of Stay on Readmissions for Children With Newly Diagnosed Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2016; 38:329-33. [PMID: 26989914 DOI: 10.1097/mph.0000000000000559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although regimens for induction therapy in children with acute lymphoblastic leukemia (ALL) are similar across the United States, typical practice with regard to inpatient length of stay (LOS) varies by institution. US children's hospitals were categorized by typical induction LOS; and readmissions, pediatric intensive care unit (PICU) admissions, and average adjusted charges were compared for the first 30 days from initial admission. Using Pediatric Health Information System data, we extracted ALL induction admissions from 2007 to 2013. We categorized hospitals into 3 categories based on median LOS: short (≤7 d), medium (8 to 15 d), or long (≥16 d). Median LOS varied from 5 to 31 days across hospitals. Thirty-day median inpatient costs per patient ranged from $32 K for short LOS, $40 K for medium LOS, and $47 K for long LOS. Compared with short LOS hospitals (n=14), medium LOS (n=8) and long LOS hospitals (n=8) had lower odds of PICU readmissions (odds ratio [OR], 0.68; P=0.0124 and OR, 0.31; P<0.001, respectively), and long LOS hospitals had lower odds of any readmission (OR, 0.44; P<0.0001). Average LOS for children with newly diagnosed ALL varies widely by institution. Children's hospitals that typically admit new ALL patients for >7 days have fewer PICU readmissions but substantial increase in total induction inpatient costs.
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Caniza MA, Odio C, Mukkada S, Gonzalez M, Ceppi F, Chaisavaneeyakorn S, Apiwattanakul N, Howard SC, Conter V, Bonilla M. Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries. Expert Rev Hematol 2015. [PMID: 26211675 DOI: 10.1586/17474086.2015.1071186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infections are the most important cause of morbidity and mortality in children treated for acute lymphoblastic leukemia (ALL). The rates of infection-associated mortality are up to 10-times higher in low- and middle-income countries (LMIC) than in high-income countries. The prevention, early recognition and management of infectious complications is especially challenging in LMIC because of disease and poverty-related factors, as well as the shortage of trained personnel, supplies, diagnostic tools and adequate organizational infrastructure. Children in LMIC with ALL, who are frequently underweight, are at increased risk of community-acquired pathogens, nosocomial multidrug-resistant pathogens and opportunistic microorganisms. This review summarizes the challenges of managing the major categories of infections in children receiving treatment for ALL and provides updated practical recommendations for preventing and managing these infections in LMIC.
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Affiliation(s)
- Miguela A Caniza
- a 1 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
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11
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Esbenshade AJ, Di Pentima MC, Zhao Z, Shintani A, Esbenshade JC, Simpson ME, Montgomery KC, Lindell RB, Lee H, Wallace A, Garcia KL, Moons KG, Debra L. F. Development and validation of a prediction model for diagnosing blood stream infections in febrile, non-neutropenic children with cancer. Pediatr Blood Cancer 2015; 62:262-268. [PMID: 25327666 PMCID: PMC4402108 DOI: 10.1002/pbc.25275] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/20/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pediatric oncology patients are at increased risk for blood stream infections (BSI). Risk in the absence of severe neutropenia (absolute neutrophil count [ANC] ≥500/µl) is not well defined. PROCEDURE In a retrospective cohort of febrile (temperature ≥38.0° for >1 hr or ≥38.3°) pediatric oncology patients with ANC ≥500/µl, a diagnostic prediction model for BSI was constructed using logistic regression modeling and the following candidate predictors: age, ANC, absolute monocyte count, body temperature, inpatient/outpatient presentation, sex, central venous catheter type, hypotension, chills, cancer diagnosis, stem cell transplant, upper respiratory symptoms, and exposure to cytarabine, anti-thymocyte globulin, or anti-GD2 antibody. The model was internally validated with bootstrapping methods. RESULTS Among 932 febrile episodes in 463 patients, we identified 91 cases of BSI. Independently significant predictors for BSI were higher body temperature (Odds ratio [OR] 2.36 P < 0.001), tunneled external catheter (OR 13.79 P < 0.001), peripherally inserted central catheter (OR 3.95 P = 0.005), elevated ANC (OR 1.19 P = 0.024), chills (OR 2.09 P = 0.031), and hypotension (OR 3.08 P = 0.004). Acute lymphoblastic leukemia diagnosis (OR 0.34 P = 0.026), increased age (OR 0.70 P = 0.049), and drug exposure (OR 0.08 P < 0.001) were associated with decreased risk for BSI. The risk prediction model had a C-index of 0.898; after bootstrapping adjustment for optimism, corrected C-index 0.885. CONCLUSIONS We developed a diagnostic prediction model for BSI in febrile pediatric oncology patients without severe neutropenia. External validation is warranted before use in clinical practice. Pediatr Blood Cancer 2015;62:262-268. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Adam J. Esbenshade
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - M. Cecilia Di Pentima
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville TN, USA
| | - Zhiguo Zhao
- Vanderbilt Department of Biostatistics, Nashville, TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Ayumi Shintani
- Vanderbilt Department of Biostatistics, Nashville, TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Jennifer C. Esbenshade
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville TN, USA
| | | | | | | | - Haerin Lee
- Vanderbilt School of Medicine, Nashville, TN, USA
| | - Ato Wallace
- Vanderbilt School of Medicine, Nashville, TN, USA
| | | | - Karel G.M. Moons
- Vanderbilt Department of Biostatistics, Nashville, TN, USA,Julius Center for Health Sciences and Primary Care, UMC Utrecht, The Netherlands
| | - Friedman Debra L.
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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