Outcome of bacteremia and fungemia in paediatric oncology patients

Abstract

Objective: To determine the outcome of paediatric oncology patients with positive blood cultures.

Design: Retrospective chart review.

Setting: Tertiary care hospital.

Population studied: Oncology patients up to 17 years of age with positive blood cultures from January 1, 1994 to March 31, 1999.

Main results: There were 121 episodes of positive blood cultures in 76 patients. Seventeen episodes were excluded because blood cultures were contaminated. Of the organisms grown from the remaining episodes, 63% were Gram-positive organisms, 23% were Gram-negative organisms, 3% were fungal and 11% were mixed. There were 13 episodes with pure or mixed isolates of Staphylococcus aureus, of which nine occurred within 14 days of the placement of a new central venous tunnelled catheter. Central venous tunnelled catheters were retained in 76 of the 102 episodes when they were present. There were two relapses, and four children were admitted to the intensive care unit with septic shock, but all survived.

Conclusions: The outcome was excellent with the current management of possible bacteremia in paediatric oncology patients, but the high incidence of S aureus bacteremia suggests that empirical antibiotics should be altered if sepsis is suspected within 14 days of the placement of a central venous catheter.

Keywords: Bacteremia; Empirical antibiotics; Fungemia; Oncology; Paediatric.

Figure 1

Outcome of 119 episodes of bacteremia in paediatric oncology patients with central venous tunnelled catheters (another two episodes occurred in patients without a central venous tunnelled catheter). Four episodes occurred in patients with implanted ports and 117 episodes in patients with Broviacs (CR Bard Inc, USA). All the catheters that were removed were Broviacs except one implanted port in a patient with fungemia