Septicemia and septic shock in pediatric patients: 140 consecutive cases on a pediatric hematology-oncology service.
OBJECTIVE
This report describes the incidence of septic shock in pediatric hematology-oncology patients with positive blood cultures and investigates parameters of potential use in early diagnosis of gram-negative (GN) bacteremia and septic shock.


METHODS
In a 12-month period, 140 consecutive episodes of septicemia (135 bacterial and 5 fungal) were seen in 100 patients. The absolute neutrophil count (ANC) was > 500/microl in 89 episodes (65%).


RESULTS
Septic shock developed in patients with positive blood cultures with an overall incidence of approximately 19%. Of the 12 bacteremic patients who required transfer to the intensive care unit, 83% had a GN isolate recovered. The incidence of septic shock was not significantly lower in the group of patients with ANC > 500/microl. Low serum bicarbonate correlated with GN infection in patients with bacteremia.


CONCLUSIONS
GN organisms were the major cause of septic shock in a group of pediatric hematology-oncology patients with positive blood cultures although they were recovered less frequently than gram-positive organisms. In our study, non-neutropenic patients with indwelling catheters were at approximately the same risk for GN shock as neutropenic patients. Monitoring blood carbon dioxide content may be useful in the early diagnosis of GN infection.
Aledo
A
A
New York Hospital-Cornell Medical Center, New York City 10021, USA.
Heller
G
G
Ren
L
L
Gardner
S
S
Dunkel
I
I
McKay
S W
SW
Flombaum
C
C
Brown
A E
AE
D000293:Adolescent; D000328:Adult; D001639:Bicarbonates / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000150:complications / Q000453:epidemiology; D018805:Sepsis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012772:Shock, Septic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015996:Survival Rate
D001639:Bicarbonates