title: A prospective study of septicaemia on a paediatric oncology unit: a three-year experience at The Royal Liverpool Children's Hospital, Alder Hey, UK.
abstract: Septicaemia in neutropaenic patients is predominantly due to gut translocation [endogenous septicaemia] and contamination of the central venous catheter by microorganisms not carried by the patient [exogenous septicaemia]. To control both types of infection, a protocol was implemented based on pre 1990's parenteral and enteral antimicrobials together with strict hygiene. Surveillance cultures of throat/rectum were taken to distinguish exogenous from endogenous septicaemia and enteral non-absorbable antibiotics are administered as part of selective decontamination of the digestive tract (SDD). This protocol was evaluated in a 14-bedded paediatric oncology unit over a period of 3 years. 313 Septicaemia episodes were recorded in 131 children. 28.4% of the septicaemias were caused by microorganisms associated with the unit, equivalent to 0.82 episodes per 100 patient days. Low-level pathogens such as coagulase-negative staphylococci caused more than 70% of infections. Amongst the potential pathogens, Pseudomonas species (7.8%) and Staphylococcus aureus (5.5%) were predominant. Antibiotic resistance was rare with no superinfections or outbreaks. Four patients (3%) died, two due to Candida species and two due to Pseudomonas aeruginosa. We believe that the addition of enteral non-absorbable antibiotics to systemic antibiotics maintained a low level of resistance and mortality but a randomised controlled trial is indicated to confirm these observations.
authors.affiliation: Department of Paediatric Oncology, The Royal Liverpool Children's Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom.
authors.forename: S C
authors.initials: SC
authors.lastname: Paulus
authors.forename: H K F
authors.initials: HK
authors.lastname: van Saene
authors.forename: S
authors.initials: S
authors.lastname: Hemsworth
authors.forename: J
authors.initials: J
authors.lastname: Hughes
authors.forename: A
authors.initials: A
authors.lastname: Ng
authors.forename: B L
authors.initials: BL
authors.lastname: Pizer
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000517:prevention & control*; D004351:Drug Resistance; D004739:England; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D017053:Infection Control / Q000379:methods*; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D018805:Sepsis / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents