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Septicaemia in childhood malignancy
Insights
Pediatric septicaemia in children with malignant diseases is a serious concern. Prompt identification of causative bacteria and tailored antibiotic therapy are crucial for improving outcomes and reducing mortality.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Septicaemia poses a significant risk to children with malignant diseases.
- Understanding the epidemiology and outcomes of septicaemia in this vulnerable population is critical for effective management.
Purpose of the Study:
- To analyze the incidence, causative agents, and outcomes of septicaemia in hospitalised children with malignant diseases.
- To identify risk factors associated with mortality in pediatric septicaemia.
Main Methods:
- Retrospective analysis of 44 septicaemia episodes in 32 children over 5.5 years.
- Data collection included patient demographics, underlying malignancy, isolated pathogens, and treatment outcomes.
- Correlation of mortality with factors such as granulocyte count, remission status, and causative microorganisms.
Main Results:
- Leukaemia was the most common underlying malignancy (52%), followed by malignant lymphoma.
- Staphylococcus aureus, coagulase-negative staphylococci, and Escherichia coli were the most frequent isolates.
- Overall mortality was 14%, with higher rates in Gram-negative infections and in children with low granulocyte counts (<0.5 X 10(9)/L) and without remission.
Conclusions:
- Septicaemia in children with malignant diseases, particularly leukaemia, requires vigilant monitoring.
- Prompt identification of pathogens and adjustment of antibiotic regimens based on microbial data and patient's clinical status are essential.
- Focus on neutropenic patients not in remission is critical for reducing mortality.
Abstract:
In this study, 44 episodes of septicaemia occurred in 32 children over a 5 1/2 year period. The mean number of hospitalised children with malignant diseases was 88 a year. During the study period, there were a total of 1,818 admissions. The mean age was 7 years (2 months to 16 years) with a male predilection (66%). The majority of septicaemias occurred in children with leukaemia (52%), but their mortality was lower than in children with malignant lymphoma. No children with solid tumours died in connection with septicaemia. All deaths in connection with septicaemia occurred in children with less than 0.5 X 10(9) granulocytes per litre, and none of these children were in remission. Twelve different bacterial species were isolated with Staphylococcus aureus, coagulase negative staphylococci, and Escherichia coli, accounting for 75% of these episodes. The mortality was 14%, most often (67%) in connection with septicaemia caused by Gram-negative organisms. It is emphasised that the type of infecting microorganisms and the outcome of the infections must be recorded regularly and the antibiotic regimen adjusted accordingly.