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Predictive factors for blood stream infections in children with cancer
Dimitrios Doganis1, Basim Asmar, Maxim Yankelevich
1Hematology/Oncology Division, Children's Hospital of Michigan, School of Medicine, Wayne State University, Detroit, MI, USA. doganisd@gmail.com
Insights
Blood Stream Infections (BSI) are a serious threat to children with cancer. Younger age, specific medical factors, and catheter use significantly increase BSI risk in pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Blood Stream Infections (BSI) pose a significant life-threatening risk for pediatric cancer patients.
- Prompt identification of risk factors is crucial for timely intervention and improved outcomes in this vulnerable population.
Purpose of the Study:
- To identify clinical and laboratory variables associated with Blood Stream Infections (BSI) in pediatric patients diagnosed with malignancy.
- To determine predictive factors for BSI in children undergoing cancer treatment.
Main Methods:
- Retrospective study analyzing blood cultures from newly diagnosed pediatric cancer patients between January 1, 2005, and December 31, 2009.
- Evaluation of 1004 infection episodes in 261 patients, with 198 classified as true BSI (19.7%).
- Univariate and multivariate logistic regression analyses were employed to identify significant predictive factors.
Main Results:
- Univariate analysis identified younger age, African American race, high fever, chills, hypotension, recent chemotherapy, history of Stem Cell Transplantation, low hemoglobin, low platelet count, and low Absolute Neutrophils count as predictive of BSI.
- Catheter presence, particularly tunneled or multiple lumen types, increased BSI likelihood.
- Multivariate analysis confirmed younger age, African American race, chills/hypotension, tunneled/multiple lumen catheters, recent antibiotic use, and low platelet count as significant independent predictors of BSI.
Conclusions:
- Younger age, African American race, specific clinical signs (chills, hypotension), advanced catheter use, recent antibiotic exposure, and thrombocytopenia are key indicators for BSI risk in pediatric cancer patients.
- These findings aid in risk stratification and the development of targeted preventive strategies for BSI in this high-risk group.
Abstract:
Blood Stream Infections (BSI) are among the most serious infections in children with cancer and are potentially life threatening. A retrospective study of blood cultures obtained from all newly diagnosed patients--from January 1, 2005 to December 31, 2009--with malignancy was conducted. In this study, our aim was to identify clinical and laboratory variables associated with a BSI in a child with malignancy. Among 1004 separate infection episodes detected in 261 patients, 198 were classified as true BSI (19.7%). Univariate analysis showed that factors such as younger age, race, temperature ≥40°C, presence of chills and hypotension, time interval from the last chemotherapy, treatment for recurrent disease or a history of Stem Cell Transplantation, low hemoglobin, low-Platelets count, and Absolute Neutrophils count less than 4 × 10(9)/L were predictive for a BSI. Patients with a catheter in place and especially if this catheter was tunneled and/or multiple lumen were more likely to have a BSI. Being on antibiotics, the history of a BSI during the previous month and having received a red cell or platelet transfusion during the prior 15 days also increased the likelihood for a BSI. According to a multivariate logistic regression analysis, the factors that remained significant were the younger age, the African American race, the presence of chills or hypotension, the use of tunneled or multiple lumen catheters, the administration of antibiotics during the previous 15 days and a low-PLT count.
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