Management of anorectal/perineal infections caused by Pseudomonas aeruginosa in children with malignant diseases

Carlos Angel, Christian C. Patrick, Thom Lobe, Bhaskar Rao, Ching Hon Pui

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

The role of operation for anorectal infections associated with perineal gangrene and cellulitis in children with myelosuppression from cancer chemotherapy is unclear. We evaluated anorectal/perineal infections caused by Pseudomonas aeruginosa in 16 children with malignant diseases seen over 27 years. In 12 of 16 patients, leukemia was the underlying malignancy (ALL 10, AML 2), and in 13 of 16, severe neutropenia (absolute neutrophil count <500/mm3) was present at diagnosis. Cultures of the lesions showed multiple organisms in 14 of 16 patients with Escherichia coli, Klebsiella species, and Enterococcus being the most frequent coexisting organisms. All positive blood cultures grew P aeruginosa exclusively. Of three patients with necrotizing infections, two had complete resolution with medical treatment alone; the other patient who developed this problem while on terminal care died. In none of the 16 patients was a major operation (debridement or diversion) performed. Five patients died, three of whom were considered terminally ill when the anorectal infections occurred. Four of the five deaths occurred before 1974. Since then, only 1 of 7 patients died. Excluding the three terminally ill patients, the success rate of medical therapy alone is 85% ( 11 13). The antibiotic regimen should include an aminoglycoside in synergistic combination with anti-Pseudomonas penicillin. These results suggest that operative management may have no role in the management of anorectal infections caused by P aeruginosa in children with cancer.

Original languageEnglish (US)
Pages (from-to)487-493
Number of pages7
JournalJournal of pediatric surgery
Volume26
Issue number4
DOIs
StatePublished - Jan 1 1991

Fingerprint

Pseudomonas aeruginosa
Infection
Terminally Ill
Neoplasms
Cellulitis
Gangrene
Terminal Care
Klebsiella
Enterococcus
Aminoglycosides
Debridement
Pseudomonas
Neutropenia
Penicillins
Leukemia
Neutrophils
Escherichia coli
Anti-Bacterial Agents
Drug Therapy
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Management of anorectal/perineal infections caused by Pseudomonas aeruginosa in children with malignant diseases. / Angel, Carlos; Patrick, Christian C.; Lobe, Thom; Rao, Bhaskar; Pui, Ching Hon.

In: Journal of pediatric surgery, Vol. 26, No. 4, 01.01.1991, p. 487-493.

Research output: Contribution to journalArticle

Angel, Carlos ; Patrick, Christian C. ; Lobe, Thom ; Rao, Bhaskar ; Pui, Ching Hon. / Management of anorectal/perineal infections caused by Pseudomonas aeruginosa in children with malignant diseases. In: Journal of pediatric surgery. 1991 ; Vol. 26, No. 4. pp. 487-493.
@article{c9a5bfbe8b73480aa8cdcbd865ce15ca,
title = "Management of anorectal/perineal infections caused by Pseudomonas aeruginosa in children with malignant diseases",
abstract = "The role of operation for anorectal infections associated with perineal gangrene and cellulitis in children with myelosuppression from cancer chemotherapy is unclear. We evaluated anorectal/perineal infections caused by Pseudomonas aeruginosa in 16 children with malignant diseases seen over 27 years. In 12 of 16 patients, leukemia was the underlying malignancy (ALL 10, AML 2), and in 13 of 16, severe neutropenia (absolute neutrophil count <500/mm3) was present at diagnosis. Cultures of the lesions showed multiple organisms in 14 of 16 patients with Escherichia coli, Klebsiella species, and Enterococcus being the most frequent coexisting organisms. All positive blood cultures grew P aeruginosa exclusively. Of three patients with necrotizing infections, two had complete resolution with medical treatment alone; the other patient who developed this problem while on terminal care died. In none of the 16 patients was a major operation (debridement or diversion) performed. Five patients died, three of whom were considered terminally ill when the anorectal infections occurred. Four of the five deaths occurred before 1974. Since then, only 1 of 7 patients died. Excluding the three terminally ill patients, the success rate of medical therapy alone is 85{\%} ( 11 13). The antibiotic regimen should include an aminoglycoside in synergistic combination with anti-Pseudomonas penicillin. These results suggest that operative management may have no role in the management of anorectal infections caused by P aeruginosa in children with cancer.",
author = "Carlos Angel and Patrick, {Christian C.} and Thom Lobe and Bhaskar Rao and Pui, {Ching Hon}",
year = "1991",
month = "1",
day = "1",
doi = "10.1016/0022-3468(91)91001-F",
language = "English (US)",
volume = "26",
pages = "487--493",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Management of anorectal/perineal infections caused by Pseudomonas aeruginosa in children with malignant diseases

AU - Angel, Carlos

AU - Patrick, Christian C.

AU - Lobe, Thom

AU - Rao, Bhaskar

AU - Pui, Ching Hon

PY - 1991/1/1

Y1 - 1991/1/1

N2 - The role of operation for anorectal infections associated with perineal gangrene and cellulitis in children with myelosuppression from cancer chemotherapy is unclear. We evaluated anorectal/perineal infections caused by Pseudomonas aeruginosa in 16 children with malignant diseases seen over 27 years. In 12 of 16 patients, leukemia was the underlying malignancy (ALL 10, AML 2), and in 13 of 16, severe neutropenia (absolute neutrophil count <500/mm3) was present at diagnosis. Cultures of the lesions showed multiple organisms in 14 of 16 patients with Escherichia coli, Klebsiella species, and Enterococcus being the most frequent coexisting organisms. All positive blood cultures grew P aeruginosa exclusively. Of three patients with necrotizing infections, two had complete resolution with medical treatment alone; the other patient who developed this problem while on terminal care died. In none of the 16 patients was a major operation (debridement or diversion) performed. Five patients died, three of whom were considered terminally ill when the anorectal infections occurred. Four of the five deaths occurred before 1974. Since then, only 1 of 7 patients died. Excluding the three terminally ill patients, the success rate of medical therapy alone is 85% ( 11 13). The antibiotic regimen should include an aminoglycoside in synergistic combination with anti-Pseudomonas penicillin. These results suggest that operative management may have no role in the management of anorectal infections caused by P aeruginosa in children with cancer.

AB - The role of operation for anorectal infections associated with perineal gangrene and cellulitis in children with myelosuppression from cancer chemotherapy is unclear. We evaluated anorectal/perineal infections caused by Pseudomonas aeruginosa in 16 children with malignant diseases seen over 27 years. In 12 of 16 patients, leukemia was the underlying malignancy (ALL 10, AML 2), and in 13 of 16, severe neutropenia (absolute neutrophil count <500/mm3) was present at diagnosis. Cultures of the lesions showed multiple organisms in 14 of 16 patients with Escherichia coli, Klebsiella species, and Enterococcus being the most frequent coexisting organisms. All positive blood cultures grew P aeruginosa exclusively. Of three patients with necrotizing infections, two had complete resolution with medical treatment alone; the other patient who developed this problem while on terminal care died. In none of the 16 patients was a major operation (debridement or diversion) performed. Five patients died, three of whom were considered terminally ill when the anorectal infections occurred. Four of the five deaths occurred before 1974. Since then, only 1 of 7 patients died. Excluding the three terminally ill patients, the success rate of medical therapy alone is 85% ( 11 13). The antibiotic regimen should include an aminoglycoside in synergistic combination with anti-Pseudomonas penicillin. These results suggest that operative management may have no role in the management of anorectal infections caused by P aeruginosa in children with cancer.

UR - http://www.scopus.com/inward/record.url?scp=0025809443&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025809443&partnerID=8YFLogxK

U2 - 10.1016/0022-3468(91)91001-F

DO - 10.1016/0022-3468(91)91001-F

M3 - Article

C2 - 2056413

AN - SCOPUS:0025809443

VL - 26

SP - 487

EP - 493

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 4

ER -