Bloodstream infections in pediatric patients with acute leukemia: Emphasis on gram-negative bacteria infections

Kuo, Fu Chun; Wang, Shih Min; Shen, Ching Fen; Ju, Yun Young; Ho, Tzong Shiann; Chen, Jiann Shiuh; Chen, Cheng; Liu, Ching Chuan

doi:10.1016/j.jmii.2015.08.013

Cited by 32 publications

(33 citation statements)

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“…The high rate of shock occurred because our patients were neutropenic children and adolescents, and their conditions deteriorated rapidly. Another study of E. coli bacteremia in pediatric patients with acute leukemia showed a higher shock/hypotension rate of 71% [22]. The multivariate analysis demonstrated that RDW level (> 15%) and WBC count (< 300/mm 3 ) were risk factors for shock.…”

Section: Discussionmentioning

confidence: 90%

Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

Wang

Liu

Huang

et al. 2019

J Infect Dev Ctries

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Introduction: The aim of our study was to evaluate the epidemiology, clinical features and risk factors for shock and mortality from Escherichia coli bacteremia among children and adolescents with hematological disorders. Methodology: A retrospective observational study of E. coli bacteremia in the hematology department at Xiangya Hospital from January 2013 to June 2018 was conducted. Clinical characteristics, laboratory results and antimicrobial susceptibility were analysed. Risk factors for shock and mortality were also investigated. Results: Of the 45 strains of E. coli, 73.3% were multidrug-resistant (MDR). Septic shock was observed in 51.1% of patients, and the 30-day all-cause mortality was 22.2%. The risk factors associated with shock were an elevated red blood cell distribution (RDW) value when bloodstream infections (BSIs) occurred (> 15%, OR, 6.840; 95% CI, 1.571 – 29.788) and a lower WBC count (< 300/mm3, OR, 6.761; 95% CI, 1.383 – 33.044). Multivariate analysis showed that only an elevated D-dimer level (> 0.5 mg/L, OR 12.250, 95% CI 1.268 – 118.361) was a risk factor for 30-day mortality. Furthermore, we observed decreases for RDW changes at two time points (neutropenia and BSIs occurred) in the non-shock group and survival group. Conclusions: MDR infections from E. coli bacteremia were common in pediatric hematological patients. In our setting, the laboratory results may serve as a clue for physicians to distinguish patients at higher risk for shock and mortality. Furthermore, RDW could be used as a biomarker to elucidate potential disorders in hematological patients.

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Section: Discussionmentioning

confidence: 90%

Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

Wang

Liu

Huang

et al. 2019

J Infect Dev Ctries

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“…Bloodstream infection (BSI) was defined as a positive isolate in a blood culture that was associated with clinical findings. [ 1 ] BSI is usually a serious complication of a malignant hematologic disease and can be a cause of death. Blood cultures and drug sensitivity tests were used to establish a direct basis for blood infections.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Bloodstream Infections in Pediatric Acute Leukemia

Yao

Jin

2017

Chinese Medical Journal

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Background:Acute leukemia is the most common pediatric hematological malignancy. Bloodstream infections (BSIs) are severe complications in these patients during chemotherapy. This study aimed to explore the clinical presentation and etiology of BSI, as well as the common sites of infection, and to provide a basis for the rational regarding antibiotic use.Methods:We performed a retrospective chart review of all pediatric patients who had acute leukemia accompanied by a BSI in our hospital from December 2011 to September 2015. All patients were selected based on clinical presentation and had to have at least one positive blood culture for inclusion. The basic clinical characteristics, blood culture results, and antimicrobial susceptibilities were analyzed.Results:All 231 patients had a fever; of them, 12 patients continued to have a fever. Twenty-five patients had nonremitting (NR) leukemia, and 206 patients achieved complete remission (CR). Differences in the duration of fever between the NR and CR groups were significant (9.6 ± 7.9 vs. 5.1 ± 3.8 days, P = 0.016). One hundred and eighty patients had agranulocytosis. Differences in fever duration between the agranulocytosis and nonagranulocytosis groups were significant (6.2 ± 5.1 vs. 4.1 ± 2.6 days, P = 0.001). The other sites of infection in these 231 patients were the lung, mouth, digestive tract, and rectum. Blood culture comprised 2635 samples. There were 619 samples, which were positive. Of the 619 positive blood culture samples, 59.9% had Gram-negative bacteria, 39.3% had Gram-positive bacteria, and 0.8% had fungus. The primary pathogens were Pseudomonas aeruginosa, Enterobactercloacae, Escherichia coli, and Klebsiella pneumoniae. Of these 231 patients, 217 patients were cured. The effective treatment ratio was 94%.Conclusions:Gram-negative bacteria were the main pathogenic bacteria in patients with acute leukemia in our center. NR primary illness, agranulocytosis, and drug-resistant pathogenic bacteria were all risk factors for poor prognosis.

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“…In this study, 80.2% of episodes occurred in the neutropenic period and 77.8% of them had severe neutropenia. In the study by Kuo et al neutropenia was identified in 83.5% of BSI episodes; 73% of them had severe neutropenia [11]. Responsible pathogens may vary between centers according to the use of empirical intravenous antibiotics and the rate of compliance with antisepsis procedures.…”

Section: Discussionmentioning

confidence: 98%

Bloodstream infections in pediatric hematology/oncology patients: Six years’ experience of a single center in Turkey

Kara¹,

Erat²,

Yahşi³

et al. 2019

Turk J Med Sci

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IntroductionBloodstream infections (BSIs) are the main cause of morbidity, prolonged hospitalization, increased cost, and mortality in patients [1,2]. Underlying diseases, applied chemotherapy protocols, central venous catheter (CVC), radiation therapy, surgical procedures, and mucositis may predispose patients to infections [3]. Today, more than 80% of pediatric patients receiving cancer treatment have long-term CVCs [4]. The majority of BSIs are related to the use of these catheters in children.Early diagnosis and empirical antibiotic treatment may help improve the prognosis of BSIs. However, the choice of empirical antibiotic treatment must be based on the patient's clinical status, frequently detected isolates, and their antimicrobial susceptibility patterns in the region [5]. In some hospitals, treatment of BSIs caused by multiresistant bacteria is an important problem because of increasing antibiotic resistance [6].Until the 1990s gram-positive microorganisms were the pathogens most often responsible for BSIs; today gram-negative pathogens are frequently isolated in many centers [7]. It is very important to know the local prevalence of responsible microorganisms for appropriate management. For this purpose, in our study we aimed to identify the microorganisms that were isolated from blood culture during the febrile period in pediatric hematology and oncology patients, their antimicrobial susceptibility patterns, and clinical outcomes. Materials and methods Study populationsThis was a cross-sectional study that included febrile patients with hematological and/or oncological diseases Background/aim: Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalization, and mortality in pediatric patients. Identifying the predominant microorganisms and antimicrobial susceptibilities in centers helps to select effective empirical antimicrobials which leads to positive clinical outcomes. We aimed to identify the causative microorganisms and their antimicrobial susceptibilities in patients with bloodstream infections.Materials and methods: Data belonging to patients with hematological and/or oncological diseases admitted to our hospital with fever between January 2010 and November 2015 were analyzed.Results: In total, 71 patients who had 111 bloodstream infection episodes were included. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria, and 4.4% fungi. The most common causative gram-negative pathogen was Escherichia coli and the most commonly isolated gram-positive microorganism was coagulase-negative staphylococci. Conclusion:Gram-negative microorganisms were predominant pathogens in bloodstream infections. Escherichia coli and coagulasenegative staphylococci were the most commonly isolated responsible pathogens. Beta-lactam/lactamase inhibitors were suitable for empirical treatment. However, in critical cases, colistin could have been used for empirical treatment until the culture results were available. Routine glycopep...

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Bloodstream infections in pediatric patients with acute leukemia: Emphasis on gram-negative bacteria infections

Abstract: Neutropenia was the major risk factor of BSIs in pediatric leukemic patients. BSIs of GNB were associated with severe neutropenia, systemic inflammatory responses, and high mortality.

Cited by 32 publications

References 21 publications

Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

Clinical Characteristics of Bloodstream Infections in Pediatric Acute Leukemia

Bloodstream infections in pediatric hematology/oncology patients: Six years’ experience of a single center in Turkey

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