title: Blood stream infections throught the entire course of acute lymphoblastic leukemia treatment.
abstract: The incidence, type and mortality of bacteremias were evaluated in a pediatric patient cohort, during the entire course of treatment for acute lymphoblastic leukemia (ALL). Eighty-six patients with newly diagnosed ALL were studied. A bacteremic episode was defined as blood isolation of a pathogen in the presence of clinical symptomatology of septicaemia. Bacteremias were analyzed according to the treatment element being delivered and the degree of neutropenia. A central venous catheter (CVC) was inserted at diagnosis in all patients. Fifty-two episodes of bacteremias were encountered in 38/86 (44%) patients, while 48/86 patients had no positive blood culture. Three out of the 38 patients had bacteremia and CVC area infection, simultaneously. Most blood stream infections (29/52, 56%) were documented during the induction phase. Isolated Gram-positive organisms were 48%, Gram-negative 50% and 2% of the positive blood cultures represented fungaemias. The most common Gram-positive isolates were Staphylococcus species (N=22) and the commonest Gram-negative isolated pathogens were Escherichia coli and Pseudomonas aeruginosa. The majority of bacteremias (75%) occurred during neutropenia. The initial antibiotic treatment was ceftazidime or piperacillin/tazobactam and amikacin or tobramycin. CVC was not removed in the majority of bacteremias (94%). No infection related fatality was recorded. Bacteremias constituted a severe and common complication in our patient cohort. However, infection-related fatality rate was negligible, most probably due to the prompt initiation of broad coverage antimicrobial therapy.
authors.affiliation: Department of Pediatric Hematology-Oncology, Aghia Sophia Children's Hospital, Thivon Livadias Ave Goudi, Athens, Greece. katharinakats@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Katsibardi
authors.forename: V
authors.initials: V
authors.lastname: Papadakis
authors.forename: A
authors.initials: A
authors.lastname: Charisiadou
authors.forename: A
authors.initials: A
authors.lastname: Pangalis
authors.forename: S
authors.initials: S
authors.lastname: Polychronopoulou
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology; D002442:Ceftazidime / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010878:Piperacillin / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D002442:Ceftazidime; D010878:Piperacillin