Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May 30:12:1471-1480.
doi: 10.2147/IDR.S199657. eCollection 2019.

Infectious complications in children with malignant bone tumors: a multicenter nationwide study

Krzysztof Czyzewski  1 , Przemyslaw Galazka  2 , Patrycja Zalas-Wiecek  3 , Olga Gryniewicz-Kwiatkowska  4 , Agnieszka Gietka  4 , Katarzyna Semczuk  5 , Liliana Chelmecka-Wiktorczyk  6 , Iwona Zak  7 , Malgorzata Salamonowicz  8 , Jowita Fraczkiewicz  8 , Olga Zajac-Spychala  9 , Ewa Bien  10 , Marcin Plonowski  11 , Pawel Wawrykow  12 , Filip Pierlejewski  13 , Zuzanna Gamrot  14 , Zofia Malas  15 , Weronika Stolpa  16 , Jakub Musial  17 , Jan Styczynski  1
Affiliations

Infectious complications in children with malignant bone tumors: a multicenter nationwide study

Krzysztof Czyzewski et al. Infect Drug Resist. .

Abstract

Objectives: The analysis of epidemiology, risk factors and outcome of infections in children with malignant bone tumors (MBT) undergoing chemotherapy. Methods: In this retrospective nationwide multicenter cross-sectional study, a total number of 126 children with MBT including 70 with Ewing sarcoma (ES) and 56 with osteosarcoma (OSA) were screened for infections over a period of 72 consecutive months. Results: The risk of infection was 7.15-fold higher in patients with ES as compared to the OSA group, especially concerning bacterial infections (4.1-fold increase risk). Bacterial infections occurred in 74.3% patients with ES and in 41.1% with OSA. The median time from diagnosis to first infection was 4.9 months. 33.0% of bacterial episodes were diagnosed as bloodstream (BSI), 31.1% as gastrointestinal tract, 30.1% as urinary tract infection. Infection-related mortality (IRM) from bacterial infection was 6% and 15% in ES and OSA patients, respectively. Cumulative incidence was 7.1% for invasive fungal disease and 6.3% for viral infections. The only significant risk factor for IRM was time to infection ≥5 months since the beginning of chemotherapy. All patients who have died from infection had BSI and were in neutropenia. Conclusions: Infections in the children with MBT in our study occurred with high frequency, especially in patients with ES. The most frequent were bacterial infections, while fungal and viral infections were episodic. Among the bacterial infections, bloodstream, urinary tract and gastrointestinal tract infections occurred with similar frequency. All deceased patients died due to BSI. Bacterial infection occurring ≥5 months since the beginning of chemotherapy was a risk factor for death.

Keywords: Ewing sarcoma; children; infectious complications; malignant bone tumor; osteosarcoma; risk factors analysis.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Bacterial infection incidence in patients with Ewing Sarcoma (ES) and osteosarcoma (OSA).
Figure 2
Figure 2
Infection related mortality (IRM) in patients with Ewing Sarcoma (ES) and osteosarcoma (OSA).
Figure 3
Figure 3
Survival from bacterial infection with respect to time of infection (<5 months vs ≥5 months from the primary diagnosis of bone tumor).
See this image and copyright information in PMC

References

    1. Styczynski J, Czyzewski K, Wysocki M, et al. Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study. Clin Microbiol Infect. 2016;22(2):179 e171–179 e110. doi:10.1016/j.cmi.2015.10.017 - DOI - PubMed
    1. Gooley TA, Chien JW, Pergam SA, et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med. 2010;363(22):2091–2101. doi:10.1056/NEJMoa1004383 - DOI - PMC - PubMed
    1. Choi YB, Yi ES, Kang JM, et al. Infectious complications during tandem high-dose chemotherapy and autologous stem cell transplantation for children with high-risk or recurrent solid tumors. PLoS One. 2016;11(9):e0162178. doi:10.1371/journal.pone.0162178 - DOI - PMC - PubMed
    1. Kaatsch P, Strothotte J, Becker C, Bielack S, Dirksen U, Blettner M. Pediatric bone tumors in Germany from 1987 to 2011: incidence rates, time trends and survival. Acta Oncol. 2016;55(9–10):1145–1151. doi:10.1080/0284186X.2016.1195509 - DOI - PubMed
    1. Pogorzala M, Styczynski J, Czyzewski K, et al. [Infectious complications in children with bone tumors]. Postepy N Med. 2016;29(8):551–554.

LinkOut - more resources