Trends in infection morbidity in a pediatric oncology ward, 1986–1995

Abstract

Background and Procedure. We retrospectively studied the type, severity, frequency, and outcome of febrile infectious complications in 217 cancer patients receiving cytotoxic chemotherapy (603 episodes) over a 10-year period in a single pediatric institution. Results. A total of 48.8% of the episodes occurred in severely leukopenic patients (WBC <1.0 × 10 9 /l, absolute neutrophil count <500 × 10 6 /l). In the second half of the study period febrile episodes occurred at increased frequency. The number of patients with gram-positive isolates in blood cultures increased over the years, most frequently coagulase-negative staphylococci were found. Remarkably, gram-negative bacteria increasingly resistant to the administered first-line antibiotic regimen emerged, necessitating modifications of the antimicrobial strategy every 3 years. Furthermore, Clostridium difficile-associated enterocolitis posed a clinical problem at increasing frequency since 1993. As expected, the speed of leukocyte recovery within 5 days from the onset of a febrile complication had an influence on the outcome of these episodes. Conclusions. Rapid recovery of the WBC was associated with an excellent prognosis, whereas persisting neutropenia was found to be a negative factor associated with fatal outcomes. The fatality rate of all febrile episodes (2.3%) remained the same throughout the study period despite the availability and wider use of recombinant hematopoietic growth factors since 1991. Med. Pediatr. Oncol. 32:336-343, 1999.

Minimizing Complications Related to Fever in the Postoperative Pediatric Oncology Patient

“…The management of postoperative fevers is well represented in the literature (Angel, Blasier, & Allison, 1994;De la Torre, Mandel, & Goff, 2003;Fanning et al, 1998;Fischer, Fegelman, & Johannigman, 1999;Freischlag & Busuttil, 1983;Hobar et al, 1998;Merjanian, Kiriakos, Dorey, Apel, & Oppenheim, 1998;Yeung, Buck, & Filler, 1982). The management of fevers in neutropenic cancer patients is also well established in adult and pediatric oncology and is reflected in the abundance of current literature (Ammann et al, 2003;Baorto et al, 2001;Elting, Rubenstein, Rolston, & Bodey, 1997;Hughes et al, 2002;Orudjev & Lange, 2002;Sepkowitz, 2005;Sipsas et al, 2005;Wehl et al, 1999). Unfortunately, there are no publications focusing specifically on the management of postoperative fevers in pediatric oncology patients.…”

Establishment of a Pediatric Oncology Program and Outcomes of Childhood Acute Lymphoblastic Leukemia in a Resource-Poor Area

“…The causes of treatment failure in resource-poor countries include relapse, abandonment of therapy, and death from toxicity because of suboptimal supportive care, delayed diagnosis, and comorbid conditions. [8][9][10][11][12][13][14][15][16][17][18][19] Strategies to reduce some of these problems have been studied, 17,18 and establishment of a dedicated pediatric oncology program in El Salvador was associated with an increase in ALL survival from 5% to 48%. 9…”