Background: There are significant differences among the centers in etiology of bacteremia in children with cancer. We aimed to compare bacteremic and non-bacteremic febrile episodes in these children.
Methods: Clinical, laboratory and treatment information on all febrile episodes in children with solid tumors (ST) or hematological malignancies (HM) in 5 Israeli hospitals were prospectively collected during 2008-2009.
Results: There were 863 episodes of fever in 232 children; 535 (62%) HM/lymphoma; 328 (38%) ST; 137 (16%) episodes with 166 bacteria isolated from blood. Among them Gram-positives 123 (74%): coagulase-negative Staphylococci 61 (37%), S.aureus and Streptococcus viridians 16 (10%) each, others 29 (17%); Gram-negatives: Enterobacteriaceae 27 (16%), Pseudomonas spp. 5 (3%); others 12 (7%). The following parameters were significantly more frequent in bacteremic as compared to non-bacteremic episodes: Hickman catheter/PICC lines as compared to PORT-A-CATH (<0.05); neutropenia3(p<0.01); and intensive treatment against malignancy (p=0.009). Bacteremic episodes were characterized by longer time until recovery from neutropenia, longer duration of fever and duration of antibiotics treatment; higher CRP and maximum temperature (p
Conclusion: Gram-positive pathogens remain the predominant cause of bacteremia in children with cancer in Israel. Risk of bacteremia is higher in children with increased CRP and fever following intensive treatment for malignancy. Bacteremia is associated with increased mortality rate.
This study was supported by HIPAK grant 2007.
