Trends in infection morbidity in a pediatric oncology ward, 1986-1995
✍ Scribed by Wehl, Goetz; Allerberger, Franz; Heitger, Andreas; Meister, Bernhard; Maurer, Katrin; Fink, Franz-Martin
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 152 KB
- Volume
- 32
- Category
- Article
- ISSN
- 0098-1532
No coin nor oath required. For personal study only.
✦ Synopsis
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 x 10(9)/l, absolute neutrophil count < 500 x 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.