Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

Abstract

Introduction: The aim of our study was to evaluate the epidemiology, clinical features and risk factors for shock and mortality from Escherichia coli bacteremia among children and adolescents with hematological disorders.
 Methodology: A retrospective observational study of E. coli bacteremia in the hematology department at Xiangya Hospital from January 2013 to June 2018 was conducted. Clinical characteristics, laboratory results and antimicrobial susceptibility were analysed. Risk factors for shock and mortality were also investigated.
 Results: Of the 45 strains of E. coli, 73.3% were multidrug-resistant (MDR). Septic shock was observed in 51.1% of patients, and the 30-day all-cause mortality was 22.2%. The risk factors associated with shock were an elevated red blood cell distribution (RDW) value when bloodstream infections (BSIs) occurred (> 15%, OR, 6.840; 95% CI, 1.571 – 29.788) and a lower WBC count (< 300/mm3, OR, 6.761; 95% CI, 1.383 – 33.044). Multivariate analysis showed that only an elevated D-dimer level (> 0.5 mg/L, OR 12.250, 95% CI 1.268 – 118.361) was a risk factor for 30-day mortality. Furthermore, we observed decreases for RDW changes at two time points (neutropenia and BSIs occurred) in the non-shock group and survival group.
 Conclusions: MDR infections from E. coli bacteremia were common in pediatric hematological patients. In our setting, the laboratory results may serve as a clue for physicians to distinguish patients at higher risk for shock and mortality. Furthermore, RDW could be used as a biomarker to elucidate potential disorders in hematological patients.

A retrospective study on Escherichia coli bacteremia in immunocompromised patients: Microbiological features, clinical characteristics, and risk factors for shock and death

“…In our study cohort, the rate of shock was 22.3%, which is a little higher than that reported in studies of adult patients with cancer or hematological diseases 35,36 . However, a previous study reported a rate of 51.1% for shock in pediatric hematological patients with E coli BSIs 37 . In present study, we found that adult was a protective factor for shock, which may also proved that children were more vulnerable to shock.…”

“…BSIs. 37 In present study, we found that adult was a protective factor for shock, which may also proved that children were more vulnerable to shock. However, because the number of patients included in this study is relatively small, so these results require further studies with larger size in different regions to verify.…”

Update on Febrile Neutropenia in Pediatric Oncological Patients Undergoing Chemotherapy

“…In the last years, the emergence and diffusion of MDR E. coli have been observed. In a trial performed in children with onco-hematological disorders, Wang et al reported that the frequency of septic shock was 51.1%, higher than the average rate of 5–30% in studies of patients of all ages [ 37 ]. Despite the advent of potent antibiotics, P. aeruginosa infection is one of the most serious nosocomial infections related with high mortality in patients with immunosuppression or comorbidities, including FN [ 38 , 39 ].…”

Molecular Characteristics of Escherichia coli Causing Bloodstream Infections During 2010–2015 in Tertiary Hospital, Shanghai, China

“… 5 And in China, one study showed that in 45 episodes of E. coli bacteremia, the 30-day all-cause mortality was 22.2%. 6 …”

“…5 And in China, one study showed that in 45 episodes of E. coli bacteremia, the 30-day allcause mortality was 22.2%. 6 β-lactams are commonly used in the treatment of BSI caused by E. coli. β-lactamase production remains the most important contributing factor to β-lactam resistance.…”