Outcome of gram negative infection in immunocompromised children

Gram negative infection is an important cause of mortality in patients receiving chemotherapy for malignant disease or as conditioning for stem cell transplantation. The risk of infection is thought to be greatest in those patients who are neutropenic and it is routine for these patients to receive broad spectrum antibiotic therapy when febrile. This study evaluates the outcome of gram negative infection in a mixed haematology/oncology population in a single institution.

All episodes of laboratory proven gram negative infection in patients receiving chemotherapy between January 2004 and March 2006 were included. A retrospective case-note based analysis was carried out to identify diagnosis, treatment, neutrophil count at time of infection, antibiotic therapy and clinical outcome.

One hundred six episodes of gram negative infection in 72 patients were identified. Sixty-seven percent of these were in patients receiving chemotherapy for malignant disease, 33% were in patients undergoing stem cell transplantation. Overall ICU admission rate was 13% and mortality was 6%. Coliforms, Pseudomonas and Klebsiella were the commonest isolates, and ICU admission and mortality rates were higher with Pseudomonas and Klebsiella infection than coliforms. After stem cell transplantation most episodes of gram negative infection occurred in non-neutropenic patients, while the reverse was true after chemotherapy.

Gram negative infection remains a significant cause of both ICU admission and mortality. Gram negative infection is largely confined to neutropenic periods after chemotherapy but not after stem cell transplantation. The isolation of Pseudomonas or Klebsiella confers a higher chance of both ICU admission and death.