Department Of Pediatric Hematology-Oncology Research Articles

Invasive fungal infections in a pediatric hematology-oncology department: A 16-year retrospective study

Background and Purpose: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in immunocompromised children. The purpose of our study was to evaluate the incidence of IFIs in pediatric patients with underlying hematologic malignancies and determine the patient characteristics, predisposing factors, diagnosis, treatment efficacy, and outcome of IFIs.Materials and Methods: For the purpose of the study, a retrospective analysis was performed on cases with proven and probable fungal infections from January 2001 to December 2016 (16 years)Results: During this period, 297 children with hematologic malignancies were admitted to the 2nd Pediatric Department of Aristotle University of Thessaloniki, Greece, and 24 cases of IFIs were registered. The most common underlying diseases were acute lymphoblastic leukemia (ALL; n=19,79%), followed by acute myeloid leukemia (AML; n=4, 17%) and non-Hodgkin lymphoma (NHL; n=1,4%). The crude incidence rates of IFIs in ALL, AML, and NHL were 10.5%, 18.2%, and 2.8% respectively. Based on the results, 25% (n=6) and 75% (n=18) of the patients were diagnosed as proven and probable IFI cases, respectively. The lung was the most common site of involvement in 16 (66.7%) cases. Furthermore, Aspergillus and Candida species represented 58.3% and 29.1% of the identified species, respectively. Regarding antifungal treatment, liposomal amphotericin B was the most commonly prescribed therapeutic agent (n=21), followed by voriconazole (n=9), caspofungin (n=3), posaconazole (n=3), micafungin (n=1), and fluconazole (n=1). In addition, 12 children received combined antifungal treatment. The crude mortality rate was obtained as 33.3%.Conclusion: As the findings of the present study indicated, despite the progress in the diagnosis and treatment of IFIs with the use of new antifungal agents, the mortality rate of these infections still remains high.

Evaluation of the quality-of-life (QOL) and socio-demographic characteristics of patients with leukemia and lymphoma: Comparison with sibling and control group.

e22524 Background: Pediatric cancer patients have increased survival rates with intensive and effective treatment methods which causing some chronic health problems and lower quality of life in long term follow up. In our study, patients in their active treatment period compared to patients who have completed their treatment in recent 5 years and more than 5 years groups, besides compared with their own siblings and healthy control group,evaluated in terms of quality of life ( QOL). Methods: This study has been daone in the Department of Pediatric Hematology-Oncology, Ankara University School of Medicine. A total of 191 children were included in the study, including 36 sibling, 76 children with leukemia (n:31) and lymphoma (n:45) besides 79 healthy children. The Turkish translation of the PedsQL questionnaire was used to evaluate the patients' quality of life. IBM SPSS-25 package program was used for statistical analysis. Results: When the sociodemographic characteristics of the patient, sibling and control group were examined; we determined that the patients, siblings and control groups were similar in age, age and gender. However, we found that the education level for the patient group was statisticaly signicantly lower then the siblings and the control group. In addition, physical and mental functionning and friendship capasity scores were lower in patient group than the other two groups. According to timing of the treatment; patients and parents quality of life scores were significantly lower than the patients that finished their treatment in recent 5 years or more than 5 years. QOL scores were higest in survivors and parents group that were in more than 5 years after completed the treatment. The risk of lower QOL in patients under treatment was 7.48 times higher than the children who had ≥5 years of treatment (OR = 7,48; p < 0,05), and 2.64 times higher than those who were treated < 5 years (OR = 2,64; p > 0,05). In this study, there were no independent variables that had an impact on QOL of the sibling group. Conclusions: The QOLof patients diagnosed with leukemia and lymphoma is significantly lower than siblings and healthy group. No statistically significant difference was found between the sibling group and the healthy control group. After the end of active treatment, the QOL of the patients was reflecting important increase by the time .

Retinoblastoma Presentation and Survival: A four-year analysis from a tertiary care hospital.

Objective:To study the clinical presentation, treatment, and outcome of Retinoblastoma (Rb) in a tertiary care hospital of Pakistan.Methods:A retrospective study was conducted in the Department of Pediatric Hematology Oncology, The Indus Hospital (TIH), Karachi from 1st June 2013 to 30th June 2017. Data including patients’ demography, clinical symptoms and duration, laterality, extent of the tumor, type of treatment, relapse, and final outcome were extracted and evaluated with respect to progression and survival.Results:A total of 93 patients were included; 34.4% were boys. The median age at presentation was 30 months. Leukocoria was the commonest symptom (61.3%), followed by proptosis (37.6%). Unilateral disease was seen in 59.1%, extraocular tumors in 43.5% and metastasis in 28.1%. Enucleation was performed on 46.2%, chemotherapy given to 80.6% and external beam radiation therapy to 29.3% patients.Conclusion:Delayed presentation, recurrent disease, extraocular disease and metastasis on presentation were factors affecting outcome in our cohort. Awareness about the early warning signs and symptoms in both public and health professionals for early recognition and timely management are mandatory to decrease morbidity and mortality.

Photobiomodulation with a combination of two wavelengths in the treatment of oral mucositis in children: The PEDIALASE feasibility study

Photobiomodulation is recommended in adults for the prevention of mucositis induced by cervicofacial irradiation or pre-transplant chemotherapy. The results of pediatric studies are promising but this support treatment is still underused. The objective was to conduct a feasibility study in the pediatric hematology-oncology unit at X Children's Hospital. Extra- and intraoral scans were performed a minimum of three times every 2 days for grade 2 or higher mucositis in children (median age, 8.6 years) using the Oncolase laser (Biophoton, Saint Alban, France), with a combination of two wavelengths (635 and 815nm). The effect of the laser on mucositis grade, pain, the child's tolerance, and the time dedicated to this care were also evaluated. The success of the procedure was 77% in 1 year, with the inclusion of 84% of the patients (n=22) and 146 laser treatment sessions (median of four per episode of mucositis). We observed excellent tolerance and pain relief with a gain of two points on the VAS and the HEDEN mucositis scale. This study shows that photobiomodulation that incorporates two application modes (intra- and extraoral) through the combination of two wavelengths is feasible when integrated into the care of a pediatric hematology-oncology department and is perfectly tolerated, even by young children. Along with oral hygiene and analgesic management, it alleviates pain associated with oral mucositis.

Pediatric Malignant Mediastinal Masses.

To describe the clinical spectrum and outcome-associated variables of pediatric malignant mediastinal masses in a resource-limited setting. Descriptive study. Department of Pediatric Hematology-Oncology, The Children's Hospital, Lahore, from October 2016 to November 2017. Children with malignant mediastinal masses were enrolled. The variables studied were median age at presentation, gender distribution, immunisation status, socio-economic background, causes of delayed presentation, presenting complaints, complications of disease, methods for mass biopsy, final diagnosis, staging, and outcome of the disease. Results were described in terms of descriptive statistics. The median age at diagnosis was 7.5 years with male-to-female ratio of 2:1. The commonest presenting complaint was fever (82%), respiratory distress (58%), and lymphadenopathy (51%). Seventy-eight percent patients belonged to lower socio-economic class. Eighty-six percent of patients had delayed presentation to the tertiary care hospital and the most common reason was delayed diagnosis by the medical professionals (49%). Fifty-one percent patients had weight-for-age less than 5th percentile. Common complications were airway obstruction (35%), pericardial effusion (19.6%), superior vena cava syndrome and gross pleural effusion (13.7% each). Commonest diagnosis was T-cell acute lymphoblastic leukemia (35%) followed by lymphoblastic lymphoma and Hodgkin's lymphoma (15.7% each). Fourtyfive percent patients expired, 2% defaulted treatment and 5.9% completed treatment; 25% patients were under treatment, 3.9% patients had progressive disease while outcome of 17.6% of patients could not be known. The most significant factor associated with the outcome primary diagnosis (p<0.001), delayed presentation (p=0.007) and educational status of the family. The pattern of clinical presentation, complications and diagnoses of pediatric malignant mediastinal masses showed some variation from the already reported. Low literacy rate and delay in presentation are common and contribute significantly to the poor outcome.

Vena cava superior syndrome in the children with mediastinal tumors: Single-center experience.

OBJECTIVE:Vena cava superior syndrome comprises various symptoms of compression of vena cava superior. The results of increased venous pressure in the upper body may cause edema of the head and neck associated with cyanosis, plethora and distended subcutaneous vessels. Vena cava superior syndrome is rare in childhood. Therefore, we planned this retrospective study.METHODS:The retrospective study was carried out on the children with mediastinal tumors in the Department of Pediatric Hematology-oncology, Erciyes University Faculty of Medicine, Kayseri, Turkey , from January 2010 to December 2017. Diagnostic procedures included hematological investigations, chestradiography, thoracic computed tomography, echocardiography and lymph node or mediastinal biopsy.RESULTS:In this study, 19 (five were female) of 41 patients with mediastinal tumors had Vena cava superior syndrome. Diagnosis included Hodgkin’s lymphoma in seven (37%), non-Hodgkin’s lymphoma in six (32%), acute T- lymphoblastic leukemia in four (21%), neuroblastoma and anaplastic round cell sarcoma in one each respectively. All of the 19 patients’ facial swelling, venous distention and mediastinal widening. All patients received intravenous corticosteroids (0.6 mg/kg dexamethasone). Furthermore, the patient with anaplastic round cell sarcoma received emergency radiotherapy. No patients died because of Vena cava superior syndrome.CONCLUSION:Vena cava superior syndrome is a medical emergency that requiresurgent treatment. Vena cava superior syndrome studies in children are rare. In this retrospective study, we found that the most common cause of Vena cava superior syndrome was Hodgkin’s lymphoma different from literature.

Chemotherapy-Induced Adverse Drug Reactions in Pediatric Oncology

Background: Chemotherapy accounts to high vulnerability toward Adverse Events (AEs) as it involves highly complicated regimens. Objective of the study is to identify, assess, grade and categorize chemotherapy-induced adverse drug reactions in pediatric oncology. Materials and Methods: A 6 months Prospective-observational study was conducted in pediatric hematology oncology department. 0-15 years of hospitalized patients receiving chemotherapy for cancer were enrolled. Demographic details, cytotoxic drugs used and AEs that occurred were collected in a self-designed patient profile form. AEs were studied using CTCAE version 4.03 and Naranjo’s Scale of Probability. After each cycle, follow ups were taken. Result: A total of 50 patients, of which 33 male and 17 female patients were included in the study and a total of 332 AEs were observed. AEs were segregated into organ class and the number of events observed were, Gastrointestinal (123), General Disorders (107), Musculoskeletal (23), Blood and Lymphatic (42), Eye and ear (4), Nervous (17), Respiratory (16). Drugs suspected to cause the AEs were; Vincristine 65, Daunorubicin 130, Methotrexate 107, Cyclophosphamide 42, and L’Asparginase 54. ADR may be caused by more than one chemotherapeutic drug. Using Naranjo’s Scale we observed, 6 were definite, 159 were probable and 167 were possible. On using CTCAE, out of 332 AEs, 167 were characterized as Grade 1, 114 as Grade 2, 51 as Grade 3 and 1 as Grade 5. Conclusion: Using CTCAE, most AEs were suspected to have been caused because of Daunorubicin and Methotrexate, but the severe AEs (neurotoxicity, pulmonary toxicity) were due to Vincristine, Methotrexate, and Cyclophosphamide. Key words: Chemotherapy, Pediatric cancer, Chemotherapy, ADRs, CTCAE, Organ Toxicities.

Iron overload in children with leukaemia: Experience of The Only Department of Pediatric Hematology Oncology in Kuwait

Children with leukaemia are prone to severe anaemia dueto the disease itself and the medication; they usuallyreceive multiple blood transfusions throughouttheir treatment when they develop severe anaemia as a side effect of the disease and chemotherapy received. This is an observational cross-sectional study of 50 children who werediagnosed with leukaemia and treated at NBK paediatrichaematology and oncology department, Sabah hospital.The aim of this study was to see whether intensechemotherapy affects the amount of blood transfusionsreceived, hence leading to iron overload. Serum ferritinlevel was tested in each patient who were atdifferent stages of treatment (after parents' consent). Forty-four childrenwere receiving their chemotherapy at the time ofsampling and were at different stages of theirtreatment, whereas six children have already completedtheir chemotherapy in accordance to theirchemotherapy treatment protocol. Serum ferritin level was observed to be increasing as the patient progress in treatment. The risk of the disease and multiple blood transfusions might lead to increased level of serumferritin level (multiple correlation coefficient 0.664, coefficient of determination =38%) however they were not only the only determinant of the iron overload. Most children have received multiple blood transfusions by the end of chemotherapy treatment protocol(p=0.001). Iron overload has an accumulative effect that can still be clearly seen towards the end of chemotherapy protocol.

Children with Down Syndrome and Leukemia in Kuwait-Experience of the only Pediatric Hematology Oncology Department in Kuwait

Children with Down Syndrome and Leukemia in Kuwait-Experience of the only Pediatric Hematology Oncology Department in Kuwait

Application of quality control circle in reducing PICC unplanned decannulation rate in pediatric hematology-oncology department

Objective To investigate effect of quality control circle in reducing PICC unplanned decannulation rate in pediatric hematology-oncology department. Methods Quality control circle group was established and activities were planned in August 2013. Status was investigated according to current situation of the theme. Goal was set and resolved. Group members had brainstorming and chose the main reason. Countermeasures were drawn up, carried out, reviewed, improved and standardized after effects confirmation. A total of 87 children with PICC in Nanjing Children′s Hospital from January 2012 to September 2013 were concluded to control group, while 68 children with PICC from October 2013 to May 2014 were selected as experimental group receiving quality control circle. PICC unplanned decannulation rate were compared between two groups. Results PICC unplanned decannulation rate was 11.49% in control group and 1.47% in experimental group. The difference between two groups was statistically significant (χ2=4.395, P<0.05). Conclusions Quality control circle could reduce PICC unplanned decannulation rate in pediatric hematology-oncology department, prolong the PICC usage time, guide the parents and nurses to avoid PICC nursing misunderstanding, improve group members′ management and group cooperation ability, promote nurses′ confidence and help to establish and perfect standardized PICC procedures. Key words: Quality control circle; Children; PICC; Unplanned decannulation rate

Experience in the treatment of Gaucher disease with Imiglucerase in the Department of Pediatric Hematology-Oncology at the University Hospital

Introduccion: La enfermedad de Gaucher (EG) es el trastorno metabolico de deposito mas frecuente. Es el resultado de una mutacion autosomica recesiva en el gen que codifica la enzima s-glucosidasa acida. La deficiencia enzimatica produce la acumulacion de la glucosilceramida en los lisosomas del sistema monocito macrofago llevando a la acumulacion de glucocerebrosidos, causando dano celular y disfuncion organica. Objetivos: Describir las caracteristicas clinicas de pacientes diagnosticados con EG en el Departamento de Hemato-Oncologia Pediatrica del Hospital de Clinicas y evaluar la respuesta terapeutica a la Terapia de Reemplazo Enzimatico (TRE) con la enzima Imiglucerasa. Materiales y Metodos: Estudio descriptivo de corte transversal, realizado entre enero de 2005 y diciembre de 2013. Resultados : En el periodo de estudio fueron diagnosticados 8 pacientes, 5 de sexo femenino. La edad media al diagnostico fue de 4,5 anos. Todos presentaron esplenomegalia, 7/8 hepatomegalia y 5/8 tenian afectacion osea al diagnostico. Todos presentaron afectacion hematologica. Con la TRE 7/8 alcanzaron las metas terapeuticas. El tiempo medio de normalizacion de la hemoglobina fue de 5 meses, el de las plaquetas de 11 meses. El tamano del higado se normalizo en promedio a los 10 meses y el bazo a los 14 meses. Conclusiones: La EG presenta gran heterogeneidad clinica. La respuesta a la TRE es por lo general excelente, siendo fundamental una adecuada adherencia al tratamiento.

Neuroblastoma in Saudi Children: A Single Center Experience (2006-2014)

Introduction: Neuroblastoma is the most common extracranial solid tumor in childhood and survival rate has improved during the last few decades. Only a few studies, related to Neuroblastoma in Saudi Arabian children, have been performed. We report epidemiologic data and our clinical experience from the department of Pediatric Hematology Oncology (PHO), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. Method: A retrospective observational study of all patients, with diagnosis of Neuroblastoma, who attended PHO-KFMC from July 2006 to June 2014 was performed. The survival periods (overall survival and disease-free survival) and the final outcomes for patients treated and followed at KFMC were recorded. The survival data were statistically correlated with the clinical, pathological and biological features of patients and tumors and compared to national and international cohorts. Results: Eight-year data were available for the 42 patients of which 22 (52.4%) were male and 20 (47.6%) were females. Age at diagnosis ranged 0 - 91 months with a mean and median of 26.3 and 18.5 months respectively. 16 (38.1%) patients were under one year and 26 (61.9%) above 1 year of age. The event-free survival (EFS) and overall survival (OS) rates were 66.5% and 71.5% respectively. EFS and OS among those who were detecting clinical and biologic characteristics of aggressive disease and tailoring therapy, is needed.

Seeking a Second Opinion in Pediatric Oncology

Objectives: The goal of this study was to identify second opinion consultations by physicians and to determine patient and family factors that appeared to contribute to a second opinion being sought. Methods: One hundred and fifty consecutive parents of children with cancer recently treated in our Department of Pediatric Hematology Oncology were interviewed by telephone. The questionnaire included epidemiological data, details about the disease, timing of the second opinion consultation, reasons for seeking a second opinion, and the outcome of the consultation. Results: Thirty-seven (24.7%) parents sought a second opinion. Advice was sought from other physicians in the hospital or at other clinics. There was a correlation to a higher socioeconomic status (P = .003) and to the number of educational years (P = .001). Most of the parents sought a second opinion because they wanted confirmation about the treatment protocol and the professional level of the hematologist oncologist/surgeon and the institution. Conclusions: Second opinion consultations were not uncommon and were mainly secondary to the desire for reassurance. Pediatric oncologists should ensure that patients and their families feel comfortable requesting a second opinion consultation.

Mycobacterium phocaicum bacteremia: an emerging infection in pediatric hematology-oncology patients.

Nontuberculous mycobacteria may cause central venous catheter-associated bacteremia. Between March 2011 and October 2013, 6 cases of Mycobacterium phocaicum bacteremia were found in the pediatric hematology-oncology department. All patients recovered. No positive blood culture was documented after removal of the central venous catheter. All 4 patients with pulsed field gel electrophoresis had the same pattern, different from the water sample, suggesting a common water source.

Hepatic Focal Nodular Hyperplasia Developing after Childhood Cancers: Two-Center’s Experience from Turkey.

Even though Focal nodular hyperplasia (FNH) is a rare lesion of the liver in children, it is reported at increased rates in treated pediatric cancer patients. The aim of this retrospective study is to describe the clinical and radiological characteristics and clinical course of patients diagnosed as FNH after primary malignancy in childhood. We retrospectively evaluated the diagnostic work-up, radiologic findings, clinical course and outcome of 8 patients, diagnosed as FNH after pediatric cancer treatment at the Department of Pediatric HematologyOncology of the Kanuni Sultan Suleyman Training and Research Hospital and Istanbul University, Oncology Institute, between 1993 and 2011. FNH lesions were diagnosed in 8 of 1600 solid tumors (0.5%) after a median interval of 8 (2-18) years, from the termination of the antineoplastic therapy for the primary cancer. Five patients had a history of neuroblastoma and two patients had rhabdomyosarcoma and one of them had primitive neuroectodermal tumor. FNH was incidentally found at USG or MRI performed during routine follow-up. Two children underwent surgical biopsies to rule out liver metastases. The lesions were stable for a median of 12 months (3-108 months) followup, no malign transformation was detected. FNH may be encountered as a radiological finding during follow-up in pediatric malignancies without hematopoetic stem cell transplantation and may be misdiagnosed as liver metastasis. FNH should be considered in the differential diagnosis of liver lesions encountered during follow up children with cancer. After the diagnosis of these benign lesions radiologically without biopsy, close imaging follow-up is recommended.

Psychological workshops for children and adolescents suffering from malignant disease: The model of psychosocial support during hospitalization and treatment

Pediatric psycho-oncology within psycho-oncology is a highly developed scientific discipline in the world, both at the level of basic research and the development of theoretical concepts and at the practical level, which refers to the creation and implementation of various models of psychosocial support to children and young people who are suffering from various malignant diseases and their families during all stages of the demanding oncology treatment. One of the models of psychosocial support for children are workshops, as a form of group psychological treatment in which children and young people who are in distress, crisis, shock and even trauma, acquire a new positive experience and which provides new insights and knowledge to empower and boost the quality of life for overcoming severe malignant disease and treatment through meaningful games, all of which leads to overcoming the 'downtime' and regression and encouraging further psychological development. The outcome of workshop activities are various products (drawings, photographs, videos, posters, written material), but also positive feelings and behaviours in children and adolescents. The main objectives of introducing psychological workshops at the department of pediatric hematology-oncology in our community are, on the one hand, to provide professional counselling and support to children and young people during hospitalization and, on the other, to introduce a standard psychological procedure and quality psychological practice of group psychological counselling for sick children and young people in the hospital environment.

Epidemiology of bacterial isolates among pediatric cancer patients from a tertiary care oncology center in North India.

Infections are a major cause of morbidity and mortality in pediatric oncology. Resistance pattern of bacterial isolates determine empiric antibiotic therapy and influence outcome. This study was planned to determine profile of bacterial isolates and their antibiotic resistance pattern among pediatric cancer patients. It was a retrospective, single institutional study. The study was carried out in the department of pediatric hematology-oncology of a tertiary care cancer centre in north India over a period of 24 months (2012-2014). Microbiological data pertaining to pediatric cancer patients, less than 18 yrs of age was analysed. Hence, 238 bacterial isolates were cultured from among 1757 blood, urine and other specimens. Gram negative bacteria were the most common (74%) pathogens identified and E. coli and Klebsiella comprised 80% of them. A high incidence of extended spectrum beta lactamase producing organisms (84%), beta-lactam beta-lactamase inhibitor (78%) and carbapenem resistance was observed (29%). Blood stream infection with multi-drug resistant Klebsiella was associated with high mortality. The gram positive bacteria isolated were predominantly staphylococcus aureus and were antibiotic sensitive. Reduction in the number of culture positive isolates in the second year of our study was probably due to rigorous implementation of infection control measures. These results on microbiologic profile and antibiotic sensitivity pattern of the isolates will be extremely helpful in revision of antibiotic guidelines for our patients and in developing strategies for coping with high prevalence of multi-drug resistance. Antibiotic stewardship and strict implementation of infection control practices will be important components of this effort.

Molecular-based Diagnosis of Bacteremia in the Setting of Fever With or Without Neutropenia in Pediatric Hematology-Oncology Patients

Prompt evaluation and appropriate treatment with wide-spectrum antibiotics is considered mandatory for febrile oncology patients especially during neutropenia. Central venous catheters are widely used in pediatric oncology patients and are often the source of infections. Patients are usually admitted for follow-up and administration of antibiotics. Aims were to assess the efficacy of the polymerase chain reaction (PCR) method in identifying bacteria in blood samples as compared with standard blood cultures. This was a prospective study, which included all patients with central venous catheters admitted to the pediatric hematology-oncology department over the 14-month period. Demographic, clinical, and laboratory variables were compared in bacteremic and nonbacteremic patients. Standard microbiological cultures were compared using the PCR technique. From September 2004 to November 2005, 148 blood cultures (70 patients) were evaluated. Positive blood cultures were detected on 21 (18.3%) occasions. PCR had sensitivity of 46%, specificity of 98%, positive predictive value 86%, and negative predictive value 89%. The PCR identified fastidious bacteria in 2 occasions when standard cultures were negative. Inspite of low sensitivity, PCR may help with early identification of bacteremia. Improving this technology is warranted.

Adenovirus pneumonia during induction therapy for childhood acute lymphoblastic leukemia

Pediatric Blood & CancerVolume 60, Issue 8 p. 1390-1391 Letter to the Editor Adenovirus pneumonia during induction therapy for childhood acute lymphoblastic leukemia Désirée Caselli MD, Corresponding Author Désirée Caselli MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, Italy Correspondence to: Désirée Caselli, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, Itlay. E-mail: [email protected]Search for more papers by this authorAnnalisa Tondo MD, Annalisa Tondo MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorFabio Tucci MD, Fabio Tucci MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorTommaso Casini MD, Tommaso Casini MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorOlivia Paolicchi MD, Olivia Paolicchi MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorSara Savelli MD, Sara Savelli MD Department of Radiology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorMaurizio Aricò MD, Maurizio Aricò MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this author Désirée Caselli MD, Corresponding Author Désirée Caselli MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, Italy Correspondence to: Désirée Caselli, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, Itlay. E-mail: [email protected]Search for more papers by this authorAnnalisa Tondo MD, Annalisa Tondo MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorFabio Tucci MD, Fabio Tucci MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorTommaso Casini MD, Tommaso Casini MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorOlivia Paolicchi MD, Olivia Paolicchi MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorSara Savelli MD, Sara Savelli MD Department of Radiology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this authorMaurizio Aricò MD, Maurizio Aricò MD Department of Pediatric Hematology-Oncology, Azienda Ospedaliero-Universitaria Meyer Children Hospital, Firenze, ItalySearch for more papers by this author First published: 29 April 2013 https://doi.org/10.1002/pbc.24550Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume60, Issue8August 2013Pages 1390-1391 RelatedInformation

Catheter-associated Bloodstream Infections in Pediatric Hematology-Oncology Patients

Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.