Gramnegativ sepsis hos barncancerpatienter i Göteborg; kliniska aspekter

Abstract

Background: Children with cancer or children after stem cell transplantation have an increased risk of neutropenic infections. Previous studies have shown that the incidence of gram-negative bacteraemia has increased in these patients and is also associated with a greater morbidity and mortality. Aim: To describe the bacteriological and clinical data associated with gram-negative sepsis in pediatric cancer patients in Gothenburg during a five-year period. Methods: The study population consisted of all cases of fever and concomitant finding of gram-negative bacteria in blood cultures between July 2013 and June 2018 at Children’s Cancer Centre in Gothenburg. The study was conducted in a retrospective manner and 29 selected variables including diagnosis, age, gender, bacteria, antibiotic resistance, blood cell count and outcome variables were collected by reviewing medical records. Outcome variables were defined as; home discharge, prolonged hospitalization and either admission to intensive care or death. Results: A total of 56 infectious episodes due to gram-negative bacteria were included. The most common bacteria E. coli (n=19), Pseudomonas (n=11) and Klebsiella (n=7) made up 66 % of all cases. 25 cases were discharged to home, 22 cases had prolonged hospitalization and nine cases were admitted to the ICU (n=6) or died (n=3). All children with non-malignant haematological diseases had undergone stem cell transplantation and had a higher risk for prolonged hospitalisation (p=0.049). None of the patients with solid tumours neither died nor were in need of intensive care. In 16 of 56 episodes the bacterial isolate was resistant to an antibiotic in the initial regimen. A significantly higher risk of antibiotic resistance was seen in infections caused by Pseudomonas (p=0.047) and Stenotrophomonas (p=0.022). No correlation to outcome variables was found. Conclusion: Children with haematological malignancies and after stem cell transplantation have a higher risk of complicated outcome of a gram-negative sepsis than patients with solid tumours. Pseudomonas and Stenotrophomonas show the highest rate of resistance to the commonly used antibiotics. The results can be used to improve the clinical guidelines for febrile neutropenia in pediatric cancer patients in Sweden.