Willis Daniel N, McGlynn Mary Claire, Reich Patrick J, Hayashi Robert J
Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, United States.
Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, United States.
Front Oncol. 2023 Jan 11;12:1063253. doi: 10.3389/fonc.2022.1063253. eCollection 2022.
Bloodstream infections (BSI) continue to represent a significant source of morbidity for pediatric oncology patients, however less is known regarding this population's risk of death. We sought to evaluate the risk of BSI and death at a large pediatric cancer center.
We retrospectively collected inpatient data from pediatric oncology and hematopoietic stem cell transplant (HSCT) patients over a 9-year period. We performed univariate and multivariable modeling to assess risk of BSI and mortality examining the following variables: demographics, underlying malignancy, history of HSCT, central line type, and febrile neutropenia (FN).
During the study period, 6763 admissions from 952 patients met inclusion criteria. BSI occurred in 367 admissions (5.4%) from 231 unique individuals. Risk factors for BSI include younger age, diagnoses of hemophagocytic lymphohistiocytosis or acute myeloid leukemia, ethnicity, and history of HSCT. Mortality for those with BSI was 6.5%, compared to 0.7% without (OR 7.2, CI 4.1 - 12.7, p<0.0001). In patients with BSI, admissions with FN were associated with reduced mortality compared to admissions without FN (OR 0.21, CI 0.05 - 0.94, p=0.04). In both univariate and multivariable analysis, no other risk factor was significantly associated with mortality in patients with BSI.
BSI is a significant source of mortality in pediatric oncology and HSCT patients. While demographic variables contribute to the risk of BSI, they did not influence mortality. These findings highlight the importance of BSI prevention to reduce the risk of death in pediatric oncology patients. Future studies should focus on comprehensive BSI prevention.
血流感染（BSI）仍然是儿科肿瘤患者发病的一个重要来源，然而对于该人群的死亡风险了解较少。我们试图评估一家大型儿科癌症中心的BSI和死亡风险。
我们回顾性收集了9年间儿科肿瘤和造血干细胞移植（HSCT）患者的住院数据。我们进行了单变量和多变量建模，以评估BSI和死亡率的风险，研究以下变量：人口统计学特征、潜在恶性肿瘤、HSCT病史、中心静脉导管类型和发热性中性粒细胞减少（FN）。
在研究期间，952名患者的6763次住院符合纳入标准。231名不同个体的367次住院（5.4%）发生了BSI。BSI的危险因素包括年龄较小、噬血细胞性淋巴组织细胞增生症或急性髓系白血病的诊断、种族和HSCT病史。发生BSI的患者死亡率为6.5%，未发生BSI的患者死亡率为0.7%（比值比7.2，可信区间4.1 - 12.7，p<0.0001）。在发生BSI的患者中，有FN的住院患者与无FN的住院患者相比死亡率降低（比值比0.21，可信区间0.05 - 0.94，p = 0.04）。在单变量和多变量分析中，没有其他危险因素与发生BSI的患者死亡率显著相关。
BSI是儿科肿瘤和HSCT患者死亡的一个重要来源。虽然人口统计学变量会增加BSI的风险，但它们并不影响死亡率。这些发现凸显了预防BSI对于降低儿科肿瘤患者死亡风险的重要性。未来的研究应聚焦于全面预防BSI。
