Sepsis requiring PICU admission in children with malignancy

Abstract

Aim Infection is a common problem in children treated for malignancy and a number of children will require PICU support during septic episodes. The aim of this study was to clarify which patients require admission to PICU for presumed sepsis, and what happens to them? Methods A retrospective analysis of the PICU electronic database was performed. Haemato-oncology patients admitted during a 5 year period (1st April 2006 - 1st April 2011) were selected but those with benign conditions were then excluded. The records for each admission were then analysed using a standard proforma and those admitted with the diagnosis of presumed sepsis / pneumonia were included in this analysis. Results 60 of 109 acute admissions were due to presumed sepsis / pneumonia in children with underlying malignancy. 12 admissions were due to pneumonia alone and these patients presented with only respiratory distress and no systemic involvement. Half of the admissions had underlying ALL with a further 13 having AML, 10 having a solid tumour, 5 having lymphoma and 2 JMML. Half (33) of the admissions required intensive care support (23 ventilated, 29 inotropic support). The median length of stay was 46.5 hours (5-889) but it was 112 hours in the intervention group. 33 of the admissions were found to have 41 positive blood cultures (5 fungus, 12 gram positive and 24 gram negative organisms). During 36 of the admissions the patients were neutropenic. 4 of the admissions resulted in death within the unit and 5 in death within the next two weeks as a result of the same illness. Overall mortality was 15% of those who required intensive care support. 8 of the 9 children who died had a leukaemic illness. Conclusion Sepsis is a common adverse event in children receiving treatment for malignancy and presumed sepsis / pneumonia is the main reason for PICU admission. Leukaemic patients appear more susceptible making up 75% admissions and the majority of deaths. Half of the patients admitted to our unit required ICU support and 15% of these children subsequently died.