Trends in infection morbidity in a pediatric oncology ward, 1986-1995.
METHODS
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.
Wehl
G
G
Department of Pediatrics, University of Innsbruck, Austria.
Allerberger
F
F
Heitger
A
A
Meister
B
B
Maurer
K
K
Fink
F M
FM
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001424:Bacterial Infections / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000187:drug effects / Q000472:pathogenicity; D004352:Drug Resistance, Microbial; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000401:mortality; D005260:Female; D005334:Fever / Q000150:complications; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity / Q000639:trends*; D009369:Neoplasms / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor