Abstract
Survival rates for pediatric acute leukemia vary dramatically worldwide. Infections are a leading cause of morbidity and mortality, and the impact is amplified in low and middle-income countries. Defining the epidemiology of infection in a specific health care setting is paramount to developing effective interventions. This study aimed to define the epidemiology of and outcomes from infection in children with acute leukemia treated in a large public pediatric hospital in the Dominican Republic. A retrospective cohort was assembled of children newly diagnosed with acute leukemia between July 1, 2015 to June 30, 2017 at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo. Patients were identified from the Pediatric Oncology Network Database (PONDTM) and hospital admissions from the Oncology admissions logbook. Medical records and microbiology results were reviewed to identify all inpatient invasive infections. Distance from a child’s home to the hospital was determined using ArcGIS by Esri. Infection rates were described in discrete time periods after diagnosis and risk factors for invasive infection were explored using negative binomial regression. Overall, invasive infections were common and a prominent source of death in this cohort. Rates were highest in the first 60 days after diagnosis. Gastroenteritis/colitis, cellulitis, and pneumonia were most frequent, with bacteremia common early on. Multidrug resistant bacteria were prevalent among a small number of positive cultures. In a multivariate negative binomial regression model, age ≥ 10 years and distance from the hospital > 100 km were each protective against invasive infection in the first 180 days after diagnosis, findings that were unexpected and warrant further investigation. Over one-third of patient deaths were related to infection. Interventions aimed at reducing infection should target the first 60 days after diagnosis, improved supportive care inside and outside the hospital, and increased antimicrobial stewardship and infection prevention and control measures.
Highlights
Infection is a leading cause of treatment-related morbidity and mortality among pediatric patients diagnosed with cancer throughout the world
This study aims to define the epidemiology of, risk factors for, and outcomes from infections among hospitalized children with newly diagnosed acute leukemia at Hospital Infantil Dr Robert Reid Cabral (HIRRC), the largest children’s hospital in the Dominican Republic and the primary provider of oncologic care for a large population of children in the southern half of the country
Invasive infections were common and a prominent source of death in this cohort of patients with newly diagnosed acute lymphoblastic (ALL) and acute myeloid leukemia (AML) treated at HIRRC in Santo Domingo
Summary
Infection is a leading cause of treatment-related morbidity and mortality among pediatric patients diagnosed with cancer throughout the world. Infection-related mortality is further amplified in low- and middle-income countries (LMIC), with rates up to 10 times higher than in high-income countries (HIC) [1, 2]. The source of infection-related morbidity and mortality varies between geographic locations and even between different institutions in a similar geographic location. This is likely related to variation in epidemiology of infectious pathogens and variability in access to resources to prevent, recognize, and treat infection. Instead it is paramount to first define the epidemiology of and risk factors for infection in a specific setting This knowledge can be used to inform development and implementation of effective interventions
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