title: Incidence of septicaemias and invasive mycoses in children undergoing treatment for solid tumours: a 12-year experience at a single Italian institution.
abstract: We carried out a retrospective study on the infection rate--in episodes per 100 person months at risk (p/m/r)--of septicaemia and invasive mycoses in children with solid tumours treated at a single institution between 1985 and 1996. Among 982 patients, accounting for 8108 p/m/r, 257 infectious episodes were documented, for an infection rate of 3.2. The infection rate for "intensive" treatment was greater than that for "less intensive" treatments, 3.7 compared with 0.5, respectively; P<0.001. 58% of infectious episodes were associated with neutropenia, 22% were megatherapy-related, and 39% were related to central venous catheter (CVC), while in 13% of the episodes no risk factor was identified. Of the episodes, single organism Gram-positive bacteraemias accounted for 62%, single organism Gram-negative for 23%, multiple organism bacteraemias for 7%, invasive mycoses for 4%, and isolated fungaemias for 4%. The infection rate for Gram-positive organisms decreased significantly over time (-5.9% per year; P<0.01), but increased for the Gram-negative organisms (+3.4% per year; P=0.4). This study demonstrates that the risk of bacteraemia increases in parallel with the treatment intensity, and that a considerable number of children with solid tumours develop bacteraemia in the absence of an identifiable risk factor.
authors.affiliation: Clinical Epidemiology and Biostatistics Section, Gaslini Children's Hospital, Genoa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Haupt
authors.forename: M
authors.initials: M
authors.lastname: Romanengo
authors.forename: T
authors.initials: T
authors.lastname: Fears
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
authors.forename: E
authors.initials: E
authors.lastname: Castagnola
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology*; D002405:Catheterization, Central Venous; D002648:Child; D002675:Child, Preschool; D004866:Equipment Contamination / Q000517:prevention & control; D016469:Fungemia / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D009369:Neoplasms / Q000382:microbiology / Q000628:therapy*; D011787:Quality of Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors