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High Burden of Serious Bacterial Infections in African Children Treated for Cancer
Gita Naidu1,2, Alane Izu1,3, Stelios Poyiadjis2
1From the Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Paediatric Oncology Unit, Chris Hani Baragwanath Academic Hospital.
Insights
Infections, particularly sepsis, pose a significant threat to African children undergoing cancer treatment, leading to high mortality rates. Tuberculosis and pneumonia are identified as key factors increasing the risk of death in these vulnerable patients.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Infections are a major cause of morbidity and mortality in children treated for cancer.
- Limited data exists on the incidence, causes, risk factors, and outcomes of bacterial infections in African pediatric cancer patients.
- This study aimed to describe the epidemiology of infectious morbidity and mortality in this population.
Purpose of the Study:
- To delineate the epidemiology of infectious morbidity and mortality in children with cancer in Africa.
- To identify common pathogens and risk factors associated with infections.
- To determine the outcomes and predictors of mortality in infected pediatric cancer patients.
Main Methods:
- The study enrolled 169 children aged 1-19 years diagnosed with cancer and experiencing infections.
- Infection investigations were conducted as part of routine patient care.
- Data on demographics, cancer type, infection episodes, causative agents, and outcomes were collected.
Main Results:
- Hematologic malignancies had a higher incidence of sepsis (101 episodes per 100 child-years) compared to solid tumors.
- Gram-positive bacteria (Coagulase-negative Staphylococci, Streptococcus viridans, Enterococcus faecium) and Gram-negative bacteria (Escherichia coli, Acinetobacter baumannii, Pseudomonas species) were common pathogens.
- The case fatality risk was 40.4%, with 80% attributed to sepsis. Profound neutropenia, prolonged neutropenia, profound lymphopenia, pneumonia, and tuberculosis were independently associated with increased odds of dying from sepsis.
Conclusions:
- Sepsis represents a substantial burden for African children with cancer.
- Tuberculosis and pneumonia are significant independent predictors of mortality in this patient group.
- The findings underscore the urgent need for improved infection prevention and management strategies in pediatric oncology in Africa.
Background:
Infections in children treated for cancer contribute to morbidity and mortality. There is a paucity of studies on the incidence, etiology, risk factors and outcome of bacterial infections in African children treated for cancer. The aim of the study was to delineate the epidemiology of infectious morbidity and mortality in children with cancer.
Methods:
The study enrolled children 1-19 years old with cancer and infections. Children were investigated for infection as part of standard of care.
Results:
One hundred sixty-nine children were enrolled, 82 with hematologic malignancies and 87 with solid tumors and 10.7% were HIV infected. The incidence (per 100 child-years) of septic episodes (101) microbiologically confirmed (70.9) septic episodes, Gram-positive (48.5) and Gram-negative (37.6) sepsis was higher in children with hematologic malignancies than in those with solid tumors. The most common Gram-positive bacteria were Coagulase-negative Staphylococci, Streptococcus viridans and Enterococcus faecium, while the most common Gram-negative bacteria were Escherichia coli, Acinetobacter baumannii and Pseudomonas species. The C-reactive protein and procalcitonin was higher in microbiologically confirmed sepsis. The case fatality risk was 40.4%; 80% attributed to sepsis. The odds of dying from sepsis were higher in children with profound [adjusted odds ratio (aOR) = 3.96; P = 0.004] or prolonged neutropenia (aOR = 3.71; P = 0.011) and profound lymphopenia (aOR = 4.09; P = 0.003) and independently associated with pneumonia (53.85% vs. 29.23%; aOR = 2.38; P = 0.025) and tuberculosis (70.83% vs. 34.91%; aOR = 4.3; P = 0.005).
Conclusion:
The study emphasizes the high burden of sepsis in African children treated for cancer and highlights the association of tuberculosis and pneumonia as independent predictors of death in children with cancer.
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