Korean J Hematol.  2007 Dec;42(4):343-352. 10.5045/kjh.2007.42.4.343.

Risk Factors of Bloodstream Infection Associated Mortality in Pediatric Patients with Hemato-oncologic Disease

Affiliations
  • 1Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jjseo@amc.seoul.kr
  • 2Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND: Bloodstream infection is one of the important causes of mortality, and morbidity in pediatric patients with hemato-oncologic disease. The purpose of this study was to identify the risk factors related to mortality in patients who suffered from a bloodstream infection.
METHODS
We retrospectively reviewed and analyzed the medical records of 133 pediatric patients with hemato-oncologic diseases who had episodes of bloodstream infection documented at Asan Medical Center from June 2002 through May 2005.
RESULTS
A total of 288 pathogens were isolated, and there were 17 episodes of polymicrobial infections. Among the episodes of bloodstream infection, 93.4% were caused by bacteria of which 60.1% were gram-positive bacteria, and 33.3% were gram-negative bacteria. Fungal infections accounted for 6.6% of the infections. The main pathogens included Staphylococcus epidermidis (31.3%), Pseudomonas aeruginosa (8.3%), and Klebsiella pneumoniae (7.3%). Gram-positive organisms were isolated more frequently than gram-negative organisms, and non-albicans Candida species were documented more frequently than C. albicans in our study. Infection related mortality was 8.3% (11 of 133 patients). The pulmonary infiltration on chest X-ray (CXR) (P=0.001), and a low absolute neutrophil count (< or = 500/micorL) (P=0.017) at the time of blood culture were significantly associated with mortality. Gram-negative bacterial infection (especially with Stenotrophomonas maltophilia) and fungal infection often progressed to the septic shock or death.
CONCLUSION
This study revealed that the presence of pulmonary infiltration on a CXR, neutropenia (< or = 500/microL), and gram-negative bacterial infection might be important risk factors of mortality in pediatric patients with hemato-oncologic diseases necessitating more aggressive and vigilant supportive care.

Keyword

Bloodstream infection; Childhood cancer; Risk factors; Mortality

MeSH Terms

Bacteria
Candida
Chungcheongnam-do
Coinfection
Gram-Negative Bacteria
Gram-Negative Bacterial Infections
Gram-Positive Bacteria
Humans
Klebsiella pneumoniae
Medical Records
Mortality*
Neutropenia
Neutrophils
Pseudomonas aeruginosa
Retrospective Studies
Risk Factors*
Shock, Septic
Staphylococcus epidermidis
Stenotrophomonas
Thorax

Cited by  2 articles

Clinical Investigation of Bacteremia in Children with Hemato-Oncologic Diseases
Eun Young Ko, Hyun-ju Kang, Hyo Jin Kwon, Ui Yoon Choi, Jae-Wook Lee, Dong-Gun Lee, Yeon-Joon Park, Nak-Gyun Chung, Bin Cho, Hack-Ki Kim, Jin Han Kang
Infect Chemother. 2011;43(2):191-197.    doi: 10.3947/ic.2011.43.2.191.

Etiological Agents in Bacteremia of Children with Hemato-oncologic Diseases (2006-2010): A Single Center Study
Ji Eun Kang, Joon Young Seok, Ki Wook Yun, Hyoung Jin Kang, Eun Hwa Choi, Kyung Duk Park, Hee Young Shin, Hoan Jong Lee, Hyo Seop Ahn
Korean J Pediatr Infect Dis. 2012;19(3):131-140.    doi: 10.14776/kjpid.2012.19.3.131.


Reference

1). Krupova I., Kaiserova E., Foltinova A, et al. Bacteremia and fungemia in pediatric versus adult cancer patients after chemotherapy: comparison of etiology, risk factors and outcome. J Chemother. 1988. 10:236–42.
Article
2). Hann I., Viscoli C., Paesmans M., Gaya H., Glauser M. A comparison of outcome from febrile neutropenic episodes in children compared with adults: result from four EORTC studies. Br J Haematol. 1997. 99:580–8.
3). Alexander S., Walsh T., Freifeld A., Pizzo P. Infectious complications in pediatric cancer patients. Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology. 4th ed.Philadelphia: Lippincott Williams and Wilkins;2002. p. 1239–83.
4). Pizzo PA. Evaluation of fever in the patient with cancer. Eur J Cancer Clin Oncol. 1989. 25:9–16.
5). McCullers J., Shenep J. Assessment and management of suspected infection in neutropenic patients. Patrick C, editor. Clinical management of infections in immunocompromised infants and children. 1st ed.Philadelphia: Lippincott Williams and Wilkins;2001. p. 413–49.
6). Hughes WT., Armstrong D., Bodey GP, et al. 1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. In-fections diseases society of America. Clin Infect Dis. 1997. 25:551–73.
7). Weinstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis. 1996. 23:40–6.
Article
8). El-Mahallawy H., Sidhom I., El-Din NH., Zamzam M., El-Lamie MM. Clinical and microbiologic determinants of serious bloodstream infections in Egyptian pediatric cancer patients: a one-year study. Int J Infect Dis. 2005. 9:43–51.
Article
9). Velasco E., Thuler LC., Martins CA., Dias LM., Goncalves VM. Risk factors for bloodstream infections at a cancer center. Eur J Clin Microbiol Infect Dis. 1998. 17:587–90.
Article
10). Viscoli C., Castagnola E., Giacchino M, et al. Bloodstream infections in children with cancer: a multi-centre surveillance study of the Italian association of pediatric hematology and oncology. Supportive therapy group-infectious disease section. Eur J Cancer. 1999. 35:770–4.
11). Cho SM., Lee DG., Choi JM., Yoo JH., Sin WS., Kim CC. Septic shock in hematology oncology patients with neutropenic fever. Int J Infectious Dis. 2002. 6:531–2.
12). Apisarnthanarak A., Mayfield JL., Garison T, et al. Risk factors for Stenotrophomonas maltophilia bacteremia in oncology patients: a case-control study. Infect Control Hosp Epidemiol. 2003. 24:269–74.
13). Velasco E., Byington R., Martins CS., Schirmer M., Dias LC., Goncalves VM. Bloodstream infection surveillance in cancer centre: a prospective look at clinical microbiology aspects. Clin Microbiol Infect. 2004. 10:542–9.
14). Wu PS., Lu CY., Chang LY, et al. Stenotrophomonas maltophilia bacteremia in pediatric patients-a 10-year analysis. J Microbiol Immunol Infect. 2006. 39:144–9.
15). Abi-Said D., Anaissie E., Uzun O., Raad I., Pinzcowski H., Vartivarian S. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis. 1997. 24:1122–8.
Article
16). Simoneau E., Kelly M., Labbe AC., Roy J., Laverdiere M. What is the clinical significance of positive blood cultures with Aspergillus sp in hematopoietic stem cell transplant recipients? A 23 year experience. Bone Marrow Transplant. 2005. 36:85–6.
Article
17). Kami M., Murashiqe N., Fujihara T., Sakagami N., Tanaka Y. The mechanism for low yield of blood culture in invasive aspergillosis; the clinical importance of antigen detection tests revisited. Bone Marrow Transplant. 2005. 35:303–6.
Article
18). Velasco E., Thuler LC., Martins CA., Nucci M,?Dias LM., Goncalves VM. Epidemiology of bloodstream infections at a cancer center. Sao Paulo Med J. 2000. 118:131–8.
Article
19). Tsiotou AG., Sakorafas GH., Anagnostopoulos G., Bramis J. Septic shock; Current pathogenic concepts from a clinical perspective. Med Sci Monit. 2005. 11:RA76–85.
20). Kutko MC., Calarco MP., Flaherty MB, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med. 2003. 4:333–7.
Article
21). Black CT., Hennessey PJ., Andrassy RJ. Short-term hyperglycemia depresses immunity through nonenzymatic glycosylation of circulating immunoglobulin. J Trauma. 1990. 30:830–2.
Article
22). Palmblad J. Intravenous lipid emulsions and host defense- a critical review. Clin Nutr. 1991. 10:303–8.
23). Shou J., Lappin J., Minnard EA., Daly JM. Total parenteral nutrition, bacterial translocation, and host immune function. Am J Surg. 1994. 167:145–50.
Article
24). Stoll BJ., Temprosa M., Tyson JE, et al. Dexamethasone therapy increases infection in very low birth weight infants. Pediatrics. 1999. 104:63.
Article
25). Barsic B., Beus I., Marton E., Himbele J., Klinar I. Nosocomial infections in critically ill infectious disease patients: results of a 7-year focal surveillance. Infection. 1999. 27:16–22.
Article
Full Text Links
  • KJH
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr