Bloodstream Infections at a European Pediatric Cancer Center: Trends in Epidemiology and Outcome between 2000 and 2010

Ref ID: 18775

Author:

M. Floeth, MD – Research Associate, G. Lubritz, MD – Research Associate, A. Tragiannidis, MD – Research Associate, A. Kremer, MS – Controlling Associate, G. Goletz, MS – Research Coordinator, R. Koeck, MD – Research Associate, K. Becker, MD – Profess

Author address:

Univ. Hosp., Muenster, Germany.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Little data exist on the current epidemiology of bloodstream infections (BSI) in pediatric patients with cancer and/or undergoing hematopoietic stem cell transplantation (HSCT). Methods: In a single-center, retrospective study, we analyzed all BSI in children and adolescents with cancer and/or allogeneic HSCT during the past decade and compared the time periods 2000-2004 and 2006-2010. All pts. received MRSA-Screening and prophylaxis with twice weekly TMP/SMX and non-absorbable polyenes. Quinolone prophylaxis was restricted to allo-HSCT pts., and systemic antifungal prophylaxis to pts. with AML, recurrent leukemia, and post allo-HSCT. Blood cultures were obtained for evaluation of fever and/or signs of systemic infection and further processed using standard methods. Results: 446 BSI were observed in 289 pts. (55% male; median 8 yrs; 59.2% hem. malignancies, 35.6% solid tumors, 5.6% other; 24.9% s/p allo-HSCT; 23.6% recurrent cancer; 96.7% with indwelling permanent catheter). There was a significant increase in BSI over time from 32 to 46.7 /1000 discharges and from 5.6 to 8.4 /1000 inpatient days, respectively (p<0.001) with a predominance of Gram-positive organisms (75.8%; Gram-negative, 22.3%; Candida spp., 1.9%; no trends). Coagulase-neg. staphylococci were most frequent (41.5%), followed by viridans streptococci (8.1%), Pseudomonas spp., E.coli (6.7% each), and enterococci (3.8%). While MRSA and glycopeptide-resistant enterococci were not observed, ESBL producers and multiresistant E.coli and P.aeruginosa emerged in the second period (from 0% to 3.9, 1.4 and 1.4%, respectively (p<0.001)). 31.5% of catheters were removed, and 5.5% of episodes resulted in ICU transfer. The 30-day overall mortality rate was 6% without trend over time. Conclusions: This analysis documents a significant increase in the incidence of BSI and the emergence of resistant Gram-negative organisms in pediatric cancer/HSCT pts. receiving care at a large European treatment center.

Abstract Number: G3-1547

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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