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Septicemia in children with leukemia
Insights
In pediatric leukemia patients, gram-positive bacteria caused septicemia as often as gram-negative bacteria but were less fatal. Early antibiotic choices should consider gram-positive pathogens.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Septicemia is a serious complication in children with leukemia.
- Identifying causative agents and their impact is crucial for treatment.
Purpose of the Study:
- To analyze the epidemiology and outcomes of septicemia in pediatric leukemia patients.
- To compare the clinical significance of gram-positive versus gram-negative bacterial infections.
Main Methods:
- Retrospective review of hospital records for 164 children with leukemia diagnosed between 1969 and 1975.
- Analysis of 51 septicemia episodes and 57 isolated infectious agents.
- Comparison of mortality, duration of neutropenia, and time to diagnosis based on bacterial type.
Main Results:
- Gram-positive and gram-negative bacteria were equally frequent causes of septicemia.
- Gram-negative septicemia had a significantly higher fatality rate (9/23) than gram-positive (2/24).
- Patients with gram-negative septicemia experienced longer neutropenia (19.5 days vs. 5.6 days) and diagnosis delays (29.0 days vs. 5.9 days).
Conclusions:
- Gram-positive bacteria are significant pathogens in pediatric leukemia patients with septicemia.
- Initial antibiotic therapy should include coverage for gram-positive organisms.
- Understanding these differences can improve patient outcomes and guide treatment strategies.
Abstract:
A review of the hospital records of 164 children with leukemia diagnosed between January 1969 and December 1975 disclosed 51 episodes of septicemia in 43 patients; 57 infectious agents were isolated. Gram-positive bacteria were isolated as frequently as gram-negative bacteria, each type accounting for 45.6% of all the agents isolated. Only 2 of the 24 episodes of exclusively gram-positive septicemia were fatal, whereas 9 of the 23 episodes of exclusively gram-negative septicemia were fatal. The mean duration of neutropenia was 5.6 days in patients with gram-positive septicemia and 19.5 days in patients with gram-negative septicemia, a significant difference (P less than 0.01). Gram-positive septicemia was diagnosed after a mean of 5.9 days of hospitalization and gram-negative septicemia after a mean of 29.0 days, also a significant difference (P less than 0.001). In this exclusively pediatric population of leukemic patients gram-positive agents have to be considered as potential pathogens, and initial antibiotic therapy must be selected with this fact in mind.