title: Bloodstream infection in paediatric cancer centres--leukaemia and relapsed malignancies are independent risk factors.
abstract: In a prospective multicentre study of bloodstream infection (BSI) from November 01, 2007 to July 31, 2010, seven paediatric cancer centres (PCC) from Germany and one from Switzerland included 770 paediatric cancer patients (58% males; median age 8.3 years, interquartile range (IQR) 3.8-14.8 years) comprising 153,193 individual days of surveillance (in- and outpatient days during intensive treatment). Broviac catheters were used in 63% of all patients and Ports in 20%. One hundred forty-two patients (18%; 95% CI 16 to 21%) experienced at least one BSI (179 BSIs in total; bacteraemia 70%, bacterial sepsis 27%, candidaemia 2%). In 57%, the BSI occurred in inpatients, in 79% after conventional chemotherapy. Only 56 % of the patients showed neutropenia at BSI onset. Eventually, patients with acute lymphoblastic leukaemia (ALL) or acute myeloblastic leukaemia (AML), relapsed malignancy and patients with a Broviac faced an increased risk of BSI in the multivariate analysis. Relapsed malignancy (16%) was an independent risk factor for all BSI and for Gram-positive BSI.
  
  
  CONCLUSIONS
  This study confirms relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. On a unit level, data on BSIs in this high-risk population derived from prospective surveillance are not only mandatory to decide on empiric antimicrobial treatment but also beneficial in planning and evaluating preventive bundles.
  
  
  BACKGROUND
  • Paediatric cancer patients face an increased risk of nosocomial bloodstream infections (BSIs). • In most cases, these BSIs are associated with the use of a long-term central venous catheter (Broviac, Port), severe and prolonged immunosuppression (e.g. neutropenia) and other chemotherapy-induced alterations of host defence mechanisms (e.g. mucositis). What is New: • This study is the first multicentre study confirming relapsed malignancy as an independent risk factor for BSIs in paediatric cancer patients. • It describes the epidemiology of nosocomial BSI in paediatric cancer patients mainly outside the stem cell transplantation setting during conventional intensive therapy and argues for prospective surveillance programmes to target and evaluate preventive bundle interventions.
authors: Department of Paediatrics, University of Bern, Bern, Switzerland, Roland.Ammann@insel.ch.
authors: R A
authors: RA
authors: Ammann
authors: H J
authors: HJ
authors: Laws
authors: D
authors: D
authors: Schrey
authors: K
authors: K
authors: Ehlert
authors: O
authors: O
authors: Moser
authors: D
authors: D
authors: Dilloo
authors: U
authors: U
authors: Bode
authors: A
authors: A
authors: Wawer
authors: A
authors: A
authors: Schrauder
authors: G
authors: G
authors: Cario
authors: A
authors: A
authors: Laengler
authors: N
authors: N
authors: Graf
authors: R
authors: R
authors: Furtwängler
authors: A
authors: A
authors: Simon
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D017848:Blood-Borne Pathogens; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D009364:Neoplasm Recurrence, Local; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors