Bacteremic vs. Non-bacteremic Febrile Episodes in Children with Cancer: Prospective Multicenter Study in 5 Centers in Israel
There are significant differences among the centers in etiology of bacteremia during febrile episodes in children with cancer; and trend of increase in Gram negative bacteria has been observed. The objectives of the study were to characterize and compare bacteremic and non-bacteremic febrile episodes in children with malignancies.
Data from all episodes of fever in children (0-18 years old) with solid tumors (ST) or hematological malignancies (HM) in 5 Israeli hospitals were prospectively collected during 2008-2009, including: demographical, clinical, laboratory, microbiological information, treatment and outcome. For coagulase-negative staphylococci (CONS), only 2 consecutive cultures were considered positive.
There were 863 episodes of fever in 232 children; 511 (60%) with ST; 352 (40%) HM; 135 (16%) episodes with 166 bacteria isolated from blood. Among them Gram positive bacteria 123 (74%), including CONS 61 (37%), Staphylococcus aureus and Streptococcus viridians 16 (10%) each, others 30 (17%); Gram negative bacteria including E.coli 12 (7%), Klebsiella spp. 8 (5%), Enterobacter spp. 7 (4%), Pseudomonas spp. 5 (3%), others 11 (7%).
Bacteremia was more frequent in the presence of Hickman catheter, 40/150 (27%) or PICC lines, 15/56 (29%) vs. PORT-A-CATH, 80/622 (13%) (p<0.001); when absolute neutrophil count (ANC) <100/mm3 (80/378 (21%), vs. ANC 100-499/mm3 (29/211 (14%) or ANC >500/mm3 (26/244 (11%) (p<0.001); and in patients with most intensive treatments (including AML, JMML, some relapse protocols) 32/132 (24%) vs. less intensive treatments 103/579 (15%) (p=0.01). The following parameters were significantly different in bacteremic vs. non-bacteremic episodes: duration of fever, duration of neutropenia and CRP (p<0.05 each). Mortality was 8/135 (6%) in bacteremic vs. 2/714 (0.3%) in non-bacteremic (p<0.001) episodes.
Gram positive pathogens remain the predominant cause of bacteremia in children with solid or hematological malignancies in Israel. Bacteremia is significantly more frequent following intensive chemotherapy, in the presence of Hickman or PICC line as compared to PORT-A-CATH; during deep neutropenia <100/mm3, and it is associated with increased mortality.
I. Kassis, None
D. Miron, None
Y. Shachor-Meyouhas, None
D. Engelhard, None
I. Levy, None