Invasive bacterial and fungal infections in paediatric patients with cancer

Incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009-2011

Elizabeth A. Calton, Kirsty Le Doaré, Gayle Appleby, Julia C. Chisholm, Mike Sharland, Shamez N. Ladhani, Segal L.P. Irwin A., J. Handforth, R. S. El Rifai, Luck S. Heath R., Elizabeth Tolley, D. David

Research output: Contribution to journalArticle

6 Citations (Scopus)

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. Pediatr Blood Cancer 2014;61:1239-1245.

Original languageEnglish (US)
Pages (from-to)1239-1245
Number of pages7
JournalPediatric Blood and Cancer
Volume61
Issue number7
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Bacterial Infections
Pediatrics
Incidence
Infection
Neoplasms
Hematologic Neoplasms
Second Primary Neoplasms
Central Venous Catheters
Invasive Fungal Infections
Mycoses
Coagulase
Neutropenia
Staphylococcus
Cause of Death

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Invasive bacterial and fungal infections in paediatric patients with cancer : Incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009-2011. / Calton, Elizabeth A.; Le Doaré, Kirsty; Appleby, Gayle; Chisholm, Julia C.; Sharland, Mike; Ladhani, Shamez N.; Irwin A., Segal L.P.; Handforth, J.; El Rifai, R. S.; Heath R., Luck S.; Tolley, Elizabeth; David, D.

In: Pediatric Blood and Cancer, Vol. 61, No. 7, 01.01.2014, p. 1239-1245.

Research output: Contribution to journalArticle

Calton, EA, Le Doaré, K, Appleby, G, Chisholm, JC, Sharland, M, Ladhani, SN, Irwin A., SLP, Handforth, J, El Rifai, RS, Heath R., LS, Tolley, E & David, D 2014, 'Invasive bacterial and fungal infections in paediatric patients with cancer: Incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009-2011', Pediatric Blood and Cancer, vol. 61, no. 7, pp. 1239-1245. https://doi.org/10.1002/pbc.24995
Calton, Elizabeth A. ; Le Doaré, Kirsty ; Appleby, Gayle ; Chisholm, Julia C. ; Sharland, Mike ; Ladhani, Shamez N. ; Irwin A., Segal L.P. ; Handforth, J. ; El Rifai, R. S. ; Heath R., Luck S. ; Tolley, Elizabeth ; David, D. / Invasive bacterial and fungal infections in paediatric patients with cancer : Incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009-2011. In: Pediatric Blood and Cancer. 2014 ; Vol. 61, No. 7. pp. 1239-1245.
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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. Pediatr Blood Cancer 2014;61:1239-1245.",
author = "Calton, {Elizabeth A.} and {Le Doar{\'e}}, Kirsty and Gayle Appleby and Chisholm, {Julia C.} and Mike Sharland and Ladhani, {Shamez N.} and {Irwin A.}, {Segal L.P.} and J. Handforth and {El Rifai}, {R. S.} and {Heath R.}, {Luck S.} and Elizabeth Tolley and D. David",
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T1 - Invasive bacterial and fungal infections in paediatric patients with cancer

T2 - Incidence, risk factors, aetiology and outcomes in a UK regional cohort 2009-2011

AU - Calton, Elizabeth A.

AU - Le Doaré, Kirsty

AU - Appleby, Gayle

AU - Chisholm, Julia C.

AU - Sharland, Mike

AU - Ladhani, Shamez N.

AU - Irwin A., Segal L.P.

AU - Handforth, J.

AU - El Rifai, R. S.

AU - Heath R., Luck S.

AU - Tolley, Elizabeth

AU - David, D.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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. Pediatr Blood Cancer 2014;61:1239-1245.

AB - 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. Pediatr Blood Cancer 2014;61:1239-1245.

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