Clinical and organizational risk factors for mortality during deterioration events among pediatric oncology patients in Latin America: A multicenter prospective cohort

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

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M1103 Risk Factors for the Development of Parenteral Nutrition Associated Liver Disease in a Cohort of Surgical Patients with Necrotizing Enterocolitis: A Multicenter, Prospective Cohort Study

Gastroenterology ◽

10.1016/s0016-5085(08)61579-6 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-338-A-339

Author(s):

Debora Duro ◽

Tom Jaksic ◽

Paul D. Mitchell ◽

Leslie A. Kalish ◽

Maggie McCarthy ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Liver Disease ◽

Parenteral Nutrition ◽

Necrotizing Enterocolitis ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Surgical Patients ◽

Multicenter Prospective Cohort Study ◽

Multicenter Prospective Cohort

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Chemotherapy side effects in pediatric oncology patients: Drugs, age, and sex as risk factors

Medical and Pediatric Oncology ◽

10.1002/mpo.2950160408 ◽

1988 ◽

Vol 16 (4) ◽

pp. 263-268 ◽

Cited By ~ 34

Author(s):

Samuel Lebaron ◽

Lonnie K. Zeltzer ◽

Christine Lebaron ◽

Shannon E. Scott ◽

Paul M. Zeltzer

Keyword(s):

Risk Factors ◽

Side Effects ◽

Pediatric Oncology ◽

Oncology Patients ◽

Chemotherapy Side Effects ◽

Age And Sex

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Clostridioides difficile Infections in Inpatient Pediatric Oncology Patients: A Cohort Study Evaluating Risk Factors and Associated Outcomes

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa090 ◽

2020 ◽

Author(s):

Daniel N Willis ◽

Frederick S Huang ◽

Alexis M Elward ◽

Ningying Wu ◽

Brianna Magnusen ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Pediatric Oncology ◽

Mean Difference ◽

Cell Transplant ◽

Short Term ◽

Oncology Patients ◽

Hematopoietic Stem ◽

Clostridioides Difficile ◽

Pediatric Cancer Patients

Abstract Background Clostridioides difficile infection (CDI) is a significant source of morbidity in pediatric cancer patients. Few reports to date have evaluated risk factors and short-term outcomes for this population. Methods We retrospectively evaluated pediatric oncology admissions at St Louis Children’s Hospital from 2009 to 2018. All inpatient cases of diagnosed initial CDI were identified. We aimed to investigate the prevalence of CDI and associated risk factors, including coadmission with another patient with CDI, and to evaluate short-term outcomes including length of stay and delays in subsequent scheduled chemotherapy. Results Review of 6567 admissions from 952 patients revealed 109 CDI cases (11.4% of patients). Patients with leukemia or lymphoma, compared to those with solid tumors, were more likely to have CDI (odds ratio [OR], 3 [95% CI, 1.4–6.6], and 3 [95% CI, 1.3–6.8], respectively). Autologous hematopoietic stem cell transplant (HSCT) was also a risk factor (OR, 3.5 [95% CI, 1.7–7.4]). Prior antibiotic exposure independently increased the risk for CDI (OR, 3.0 [95% CI, 1.8–4.8]). Concurrent admission with another patient with CDI also significantly increased the risk (OR, 84.7 [95% CI, 10.5–681.8]). In contrast to previous reports, exposure to acid-suppressing medications decreased the risk for CDI (OR, 0.5 [95% CI, .3–.7]). CDI was associated with increased length of stay (mean difference, 8 days [95% CI, 4.6–11.4]) and prolonged delays for subsequent chemotherapy (mean difference, 1.4 days [95% CI, .1–2.7]). Conclusions CDI in pediatric oncology patients significantly prolongs hospitalization and delays chemotherapy treatment plans. Interventions to control CDI will improve the care of pediatric oncology patients.

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Risk Factors for Candidemia in Pediatric Oncology Patients.

Blood ◽

10.1182/blood.v114.22.4735.4735 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4735-4735 ◽

Cited By ~ 2

Author(s):

Theoklis E Zaoutis ◽

Priya A Prasad ◽

A. Russell Localio ◽

Anne Reilly ◽

Louis M Bell ◽

...

Keyword(s):

Risk Factors ◽

Pediatric Oncology ◽

Research Funding ◽

Incidence Density ◽

Candida Spp ◽

Oncology Patients ◽

Targeted Interventions ◽

Significant Difference ◽

Independent Risk Factors ◽

Oncology Unit

Abstract Abstract 4735 Background Candida species are among the most common causes of bloodstream infection and are associated with significant morbidity and mortality, particularly in oncology patients. Few studies have identified the risk factors for candidemia in pediatric oncology patients. Methods We conducted a nested case-control study within a cohort of pediatric patients admitted to the oncology unit at a children's hospital between 2001 and 2004. A case was defined as a patient with a positive blood culture for Candida spp. As time at risk is an important confounding variable in nosocomial studies assessing antibiotic risk factors, we selected two controls per case based on incidence-density sampling. Demographic and clinical data were collected by medical record review. Assessment of exposures was focused on the 2 weeks prior to the development of infection (case)/study entry (control). Conditional multivariate analyses were performed to determine independent risk factors for candidemia. Results We identified 45 oncology patients with candidemia during the study period. The most commonly isolated species were C. albicans (49%), C. parapsilosis (18%), C. glabrata (9%), and C. lusitaniae (9%). The median age of cases was 6.2 years (Interquartile Range (IQR): 2.9– 13.8 years). Median time to candidemia was 12 days (IQR: 4-22 days). There was no significant difference in mortality between cases (7%) and controls (7%). Independent risk factors for candidemia included receipt of aminoglycosides for >3 days (OR: 10.51, CI: 2.96, 64.43), receipt of total parenteral nutrition (OR: 13.82, CI: 2.48, 44.49), and Graft versus Host Disease (GVHD) (OR: 15.09, CI: 0.91, 250.24). Conclusion The receipt of aminoglycosides for >3 days, use of TPN, and GVHD were independently associated with candidemia in pediatric oncology patients. These results may inform targeted interventions to reduce the risk of candidemia in pediatric oncology patients. Disclosures: Zaoutis: Merck & Co.: Research Funding; Cephalon: Research Funding; Enzon: Research Funding.

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Risk factors for cisplatin-associated ototoxicity in pediatric oncology patients

Pediatric Blood & Cancer ◽

10.1002/pbc.24138 ◽

2012 ◽

Vol 59 (1) ◽

pp. 144-148 ◽

Cited By ~ 69

Author(s):

Allison Yancey ◽

Michael S. Harris ◽

Akinbode Egbelakin ◽

Jaimie Gilbert ◽

David B. Pisoni ◽

...

Keyword(s):

Risk Factors ◽

Pediatric Oncology ◽

Oncology Patients

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Risk Factors for Relapse in Patients With Bullous Pemphigoid in Clinical Remission: A Multicenter, Prospective, Cohort Study

Yearbook of Dermatology and Dermatologic Surgery ◽

10.1016/s0093-3619(09)79551-6 ◽

2010 ◽

Vol 2010 ◽

pp. 262-263

Author(s):

S. Bhambri ◽

J.Q. Del Rosso

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Bullous Pemphigoid ◽

Prospective Cohort Study ◽

Clinical Remission ◽

Prospective Cohort ◽

Multicenter Prospective Cohort Study ◽

Multicenter Prospective Cohort

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Cardiorespiratory complications in pediatric oncology patients with COVID-19 infection

10.22541/au.161670421.11574183/v1 ◽

2021 ◽

Author(s):

Peter Schoettler ◽

Paul Sue ◽

Tamra Slone ◽

Andrew Koh

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Respiratory Failure ◽

Cancer Therapy ◽

Cardiac Function ◽

Pediatric Oncology ◽

The Novel ◽

Oncology Patients ◽

Novel Coronavirus ◽

Active Cancer

The risk of the novel coronavirus disease 2019 (COVID-19) to pediatric oncology patients is unknown. Here, we report eight pediatric oncology patients receiving active cancer therapy that tested positive for COVID-19. Three developed severe cardiorespiratory symptoms (as defined by evidence of heart failure by echocardiogram and/or intubation secondary to respiratory failure), including one death as a result of COVID-19 infection. We identified prior anthracycline exposure and pre-COVID cardiac function as significantly associated with the development of severe cardiorespiratory complications. These data merit future and further investigation of risk factors for severe complications related to COVID-19 infections in pediatric oncology patients.

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