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Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors

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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.

Conclusion: 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.

What is Known:

• 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.

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Notes

  1. Internet realisation: MedSurv GmbH, M. Hamann, Nidderau, http://www.hamann-software.de.

Abbreviations

ALL:

Acute lymphoblastic leukaemia

AML:

Acute myeloblastic leukaemia

BSI:

Bloodstream infection

CNS:

Central nervous system

CoNS:

Coagulase-negative staphylococci

CVAD:

Long-term central venous catheter (Broviac or Port type)

ESBL:

Extended spectrum beta-lactamase

HAI:

Healthcare-associated infection

ICU:

Intensive care unit

MRSA:

Methicillin-resistant Staphylococcus aureus

NI:

Nosocomial infection

PCC:

Paediatric cancer centre

STRV:

Viridans streptococci

VRE:

Vancomycin-resistant Enterococcus

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Authors Contributions

RAA, HJL and AS designed the study protocol (AS is the chairman/study leader of the Oncoped study); RAA performed the data analysis; and all of them drafted and finalised the subsequent versions of the manuscript. All other authors coordinated the sampling of the clinical data and its transfer to the study office, read, commentated and approved the different versions of the manuscript.

Conflict of interest

None of the authors declared a conflict of interest related to this study.

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Author notes

    Authors and Affiliations

    1. Department of Paediatrics, University of Bern, Bern, Switzerland

      R. A. Ammann

    2. Department of Paediatric Oncology, Haematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, 40225, Düsseldorf, Germany

      H. J. Laws

    3. Infectious Disease Research Program Centre for Bone Marrow Transplantation and Department of Paediatric Haematology/Oncology University Children’s Hospital, Muenster, Germany

      D. Schrey & K. Ehlert

    4. Paediatric Haematology and Oncology, Children’s Hospital Medical Centre, University of Bonn, Bonn, Germany

      O. Moser, D. Dilloo & U. Bode

    5. Department of Paediatrics, Technische Universität München and Paediatric Oncology Center, Munich, Germany

      A. Wawer

    6. Department of Paediatrics at the Christian-Albrechts-University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany

      A. Schrauder & G. Cario

    7. Department of Paediatric and Adolescent Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany

      A. Laengler

    8. Paediatric Oncology and Haematology, University Children’s Hospital, Homburg, Saar, Germany

      N. Graf, R. Furtwängler & A. Simon

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    Additional information

    Communicated by David Nadal

    Revisions received: 02 February 2015/12 March 2015

    R. A. Ammann and H. J. Laws contributed equally to this work.

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    Ammann, R.A., Laws, H.J., Schrey, D. et al. Bloodstream infection in paediatric cancer centres—leukaemia and relapsed malignancies are independent risk factors. Eur J Pediatr 174, 675–686 (2015). https://doi.org/10.1007/s00431-015-2525-5

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