Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors

Ammann, Roland A.; Hj, Laws; Schrey, Dominik; Ehlert, Karoline; Moser, Olga; Dilloo, Dagmar; Bode, Udo; Wawer, Angela; Schrauder, André; Cario, Gunnar; Läengler, Alfred; Graf, Norbert; Furtwängler, Rhoikos; Simon, Arne

doi:10.1007/s00431-015-2525-5

Cited by 59 publications

(90 citation statements)

References 56 publications

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“…78,93 The presence of relapsed malignancy was also associated with an increased risk of bacteremia in a large study of pediatric cancer patients. 94 Fecal colonization with resistant strains is related to an increased probability of BSIs caused by the same bacteria and the relative risk ranged from 3.4 to 4.5 for ESBL-producing E. coli. 95,96 Prophylaxis of bloodstream infection and fever during neutropenia Isolation of neutropenic patients in single rooms, observance of contact precautions and basic hygiene procedures are essential, but not sufficient, steps in infections prevention.…”

Section: Othersmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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Section: Othersmentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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“…In neutropenic adults and children, the reported proportion of patients with bacteremia is approximately 20% (range 8-36%). [80][81][82]. When assessing an unwell neutropenic child, it should be noted that the factors significantly linked to bacteremia are the duration of neutropenia with fever, bone marrow involvement of malignancy with fever, absence of clinical focus (i.e., upper respiratory viral infection) and a previous episode of severe bacterial infection [80][81][82].…”

Section: Immunocompromised Childrenmentioning

confidence: 99%

Bacteremia in children: epidemiology, clinical diagnosis and antibiotic treatment

Pai¹,

Enoch

Aliyu

2015

Expert Review of Anti-infective Therapy

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The diagnosis of bacteremia in children is important and it can be clinically challenging to recognize the signs and symptoms. The reported rates of bacteremia are higher in young children but with the increasing vaccine coverage, there has been a decrease in bacteremia due to the three vaccine preventable bacteria (Streptococcus pneumoniae, Haemophilus influenzae group b and Neisseria meningitidis). Notably, there have been increases in healthcare-associated bacteremias with a rise in Staphylococcus aureus and Gram negative bacteremias. This review provides a brief overview of the clinical diagnosis of bacteremia in children, focusing on the epidemiology, clinical characteristics, risk factors, antibiotic treatment, outcomes and preventative measures to reduce the incidence of bacteremia and improve morbidity and mortality.

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“…1 Most oncology patients and some hematology patients have a long-term central line that facilitates their treatment, and these devices can be a source of centralline-associated BSI (CLABSI). Other sources of BSI in immunosuppressed PHO patients include disrupted skin or mucosal surfaces, such as the upper or lower gastrointestinal tract, and deep-seated infections.…”

mentioning

confidence: 99%

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Gaur

Bundy

Werner

et al. 2017

Infect. Control Hosp. Epidemiol.

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objective. To assess the burden of bloodstream infections (BSIs) among pediatric hematology-oncology (PHO) inpatients, to propose a comprehensive, all-BSI tracking approach, and to discuss how such an approach helps better inform within-center and across-center differences in CLABSI rate.design. Prospective cohort study.setting. US multicenter, quality-improvement, BSI prevention network.participants. PHO centers across the United States who agreed to follow a standardized central-line-maintenance care bundle and track all BSI events and central-line days every month.methods. Infections were categorized as CLABSI (stratified by mucosal barrier injury-related, laboratory-confirmed BSI [MBI-LCBI] versus non-MBI-LCBI) and secondary BSI, using National Healthcare Safety Network (NHSN) definitions. Single positive blood cultures (SPBCs) with NHSN defined common commensals were also tracked.results. Between 2013 and 2015, 34 PHO centers reported 1,110 BSIs. Among them, 708 (63.8%) were CLABSIs, 170 (15.3%) were secondary BSIs, and 232 (20.9%) were SPBCs. Most SPBCs (75%) occurred in patients with profound neutropenia; 22% of SPBCs were viridans group streptococci. Among the CLABSIs, 51% were MBI-LCBI. Excluding SPBCs, CLABSI rates were higher (88% vs 77%) and secondary BSI rates were lower (12% vs 23%) after the NHSN updated the definition of secondary BSI (P < .001). Preliminary analyses showed across-center differences in CLABSI versus secondary BSI and between SPBC and CLABSI versus non-CLABSI rates.conclusions. Tracking all BSIs, not just CLABSIs in PHO patients, is a patient-centered, clinically relevant approach that could help better assess across-center and within-center differences in infection rates, including CLABSI. This approach enables informed decision making by healthcare providers, payors, and the public. 2017;38:690-696 Bloodstream infections (BSIs) cause morbidity and mortality and are especially concerning in pediatric hematology-oncology (PHO) patients. 1 Most oncology patients and some hematology patients have a long-term central line that facilitates their treatment, and these devices can be a source of centralline-associated BSI (CLABSI). Other sources of BSI in immunosuppressed PHO patients include disrupted skin or mucosal surfaces, such as the upper or lower gastrointestinal tract, and deep-seated infections. Frequently, an obvious source of BSI cannot be found. CLABSIs in inpatients are considered healthcare-associated infections that are preventable and must be reported 2 to payors and local, state, and federal agencies, with implications for reimbursement. 3,4 As a result, BSI surveillance in PHO inpatients has disproportionately focused on CLABSIs; the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) surveillance definition of CLABSI is widely used for this purpose. 5 A BSI from an alternate source of infection (other than the central line), defined by the NHSN as "secondary BSI," has not received similar scrutiny. Additionally, the NHSN definitio...

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Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors

Cited by 59 publications

References 56 publications

Bloodstream infections in neutropenic cancer patients: A practical update

Bloodstream infections in neutropenic cancer patients: A practical update

Bacteremia in children: epidemiology, clinical diagnosis and antibiotic treatment

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

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