title: Invasive bacterial and fungal infections in paediatric patients with cancer: incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009-2011.
abstract: BACKGROUND
  Cancer is the second most common cause of childhood deaths in the United Kingdom and infection contributes to a quarter of all cancer-related deaths. This study aimed to estimate the risk, aetiology and outcome of bloodstream bacterial and fungal infections in children with cancer within a geographically defined region in South-West London over a 3-year period.
  
  
  METHODS
  Web-based questionnaires were completed using case records of children with positive blood cultures admitted to five London hospitals during 2009-2011.
  
  
  RESULTS
  A total of 112 children with a median age of 5.4 (IQR 3.6-11.2) years had 266 significant blood cultures during 149 infection episodes. Haematological malignancy affected 68 patients (60.7%) and solid tumours 44 (39.3%). The overall bloodstream infection rate was 1.5 episodes per 1,000 days-at-risk (95% CI, 1.2-1.8) and was similar for those with haematological malignancies and solid tumours. Most episodes were attributed to central venous catheter infection (120/149, 80.5%). Coagulase-negative staphylococci were isolated in almost half the bloodstream infections (127/266; 47.7%), while Gram-negative organisms accounted for a further quarter (64/266; 24.1%). Fungal isolates from blood were uncommon (8/112 children, 7.1%) but significantly associated with neutropenia (18/149 [12.1%] vs. 1/114 [0.9%], P = 0.0004). Six children (5.4%) died, including three (2.7%; 95% CI, 0.6-7.6%) whose deaths were infection-related.
  
  
  CONCLUSIONS
  This study provides an updated risk estimate for bloodstream infections in children with cancer and adds to the framework for developing evidence-based guidance for management of suspected infections in this highly vulnerable group.
authors.affiliation: Paediatric Infectious Diseases Group, St. George's University of London, London, UK.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Calton
authors.forename: Kirsty
authors.initials: K
authors.lastname: Le Doaré
authors.forename: Gayle
authors.initials: G
authors.lastname: Appleby
authors.forename: Julia C
authors.initials: JC
authors.lastname: Chisholm
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
mesh_terms: D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008131:London / Q000453:epidemiology; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors
keywords: antimicrobial drug resistance; bacterial infections and mycoses; catheter-associated infections; child; neoplasms; neutropenia