Portal de Periódicos da CAPES

Trends in infection morbidity in a pediatric oncology ward, 1986-1995

1999; Alan R. Liss, Inc.; Volume: 32; Issue: 5 Linguagem: Inglês

10.1002/(sici)1096-911x(199905)32

1096-911X

Goetz Wehl, Franz Allerberger, Andreas Heitger, Bernhard Meister, Katrin Maurer, Franz‐Martin Fink,

Sepsis Diagnosis and Treatment

Background and Procedure We retrospectively studied the type, severity, frequency, and outcome of febrile infectious complications in 217 cancer patients receiving cytotoxic chemotherapy (603 episodes) over a 10-year period in a single pediatric institution. Results A total of 48.8% of the episodes occurred in severely leukopenic patients (WBC <1.0 × 109/l, absolute neutrophil count <500 × 106/l). In the second half of the study period febrile episodes occurred at increased frequency. The number of patients with gram-positive isolates in blood cultures increased over the years, most frequently coagulase-negative staphylococci were found. Remarkably, gram-negative bacteria increasingly resistant to the administered first-line antibiotic regimen emerged, necessitating modifications of the antimicrobial strategy every 3 years. Furthermore, Clostridium difficile-associated enterocolitis posed a clinical problem at increasing frequency since 1993. As expected, the speed of leukocyte recovery within 5 days from the onset of a febrile complication had an influence on the outcome of these episodes. Conclusions Rapid recovery of the WBC was associated with an excellent prognosis, whereas persisting neutropenia was found to be a negative factor associated with fatal outcomes. The fatality rate of all febrile episodes (2.3%) remained the same throughout the study period despite the availability and wider use of recombinant hematopoietic growth factors since 1991. Med. Pediatr. Oncol. 32:336–343, 1999. © 1999 Wiley-Liss, Inc.