Factors associated with mortality from gram-negative bacterial infections in children with cancer

Unraveling mortality risks in pediatric oncology: Exploring bloodstream coinfections and inflammatory biomarkers in COVID-19

BACKGROUND

Pediatric oncology patients face heightened mortality rates, primarily due to bacteremia exacerbated by the ongoing COVID-19 pandemic. Given hyperinflammation's role in coronavirus pathogenesis and the importance of inflammatory biomarkers in adults, we aim to explore 60-day mortality predictors in children with cancer, where research remains limited. This study aimed to investigate predictors of mortality in pediatric oncology patients with COVID-19, focusing on bacteremia and inflammatory biomarkers.

METHODS

Sixty pediatric cancer patients with COVID-19 and 60 with bacteremia (no COVID-19) were included. Bloodstream coinfections were identified, and causative species with antimicrobial sensitivities were characterized. Various inflammatory indices were calculated. Survival analyses identified risk factors for COVID-19 patients' mortality. Mortality factors in bacteremia patients were examined.

RESULTS

The 60-day OS rate of COVID-19 pediatrics was 81.7%. Worse outcomes were associated with solid tumors, ICU admission, moderate/severe COVID-19, lymphopenia, high NLR, high CLR, and Gram-negative bacteremia (p-values=0.002, 0.025, 0.042, 0.013, 0.047, 0.052, and 0.025). Multivariate analysis identified solid tumors, high NLR, and high CLR as independent factors for lower OS (p-values=0.003, 0.046, and 0.046). Bacteremia was revealed in 24 COVID-19 patients (40%). In patients with bacteremia (n=84), non-survivors exhibited higher rates of ICU admission, fever, Gram-negative bacteria (GNB), and elevated CRP (p-values=0.007, 0.038, <0.001, and 0.006), with multivariate analysis identifying GNB and ICU as independent mortality risk factors (p-values=0.002 and 0.031).

CONCLUSIONS

NLR and CLR predict mortality in pediatric oncology patients with COVID-19, with solid tumors heightening risk. Infection severity, GNB, and patient condition significantly influence outcomes of bacteremia cancer patients.

Increased rate of multidrug-resistant gram-negative bacterial infections in hospitalized immunocompromised pediatric patients

Introduction

Multidrug resistant Gram-negative bacterial infections are considered a major public health threat. Immunocompromised pediatric patients are at a great risk of severe or overwhelming infections. The aim of this study was to describe the frequency of infections with multidrug resistant (MDR) Gram-negative bacteria (GNB) in immunocompromised pediatric patients and to determine the risk factors. In addition, we aimed to identify the antimicrobial resistance patterns of these isolates.

Materials and methods

This was a retrospective observational study conducted at the American University of Beirut Medical Center (AUBMC) from 2009 to 2017. The study included immunocompromised patients 18 years of age or younger with infections caused by Gram-negative bacteria isolated from a sterile site, or nonsterile site in the setting of clinical infection.

Results

A total of 381 episodes of infection with GNB in 242 immunocompromised pediatric patients were identified. The mean age was 7.7 years. The most common pathogens were Enterobacterales followed by Pseudomonas and Acinetobacter spp. MDR GNB infections predominated causing 72% of the episodes, with alarming MDR rates among Escherichia coli (95.7%) and Klebsiella pneumoniae (82.7%). The overall rate of MDR GNB isolated increased from 62.7% in 2015 to 90% in 2017. Thrombocytopenia, chemotherapy and previous colonization or infection with the same organism during the past 12 months were found to be independent risk factors for infection with MDR GNB.

Conclusion

This study provides data on the epidemiology of infections with MDR GNB in immunocompromised pediatric patients and illustrates the alarmingly high prevalence of these infections. This necessitates the frequent revisiting of treatment guidelines in these high-risk patients and the implementation of judicious antimicrobial stewardship programs and infection control policies to stabilize or decrease the prevalence of these infections.

Cost-effectiveness of treating childhood acute myeloid leukemia at a tertiary care center in North India

INTRODUCTION

Childhood cancers are a significant global health concern, particularly in low- and middle-income countries (LMICs), where over 80% of childhood cancer patients reside. In India, acute myeloid leukemia (AML) constitutes a significant portion of childhood cancers; however, the data on the cost-effectiveness of childhood AML treatment in India and other LMICs remain limited.

METHODS

The study focused on children (<15 years of age) diagnosed with AML at a tertiary care cancer center in North India. Data, including treatment outcome, treatment-related morbidity, mortality, and costs were retrospectively collected from the electronic medical record and hospital database. Cost-effectiveness was assessed using disability-adjusted life years (DALY) averted in relation to the country-specific cost-effectiveness threshold.

RESULTS

Among 59 AML patients, treatment-related high mortality rates, abandonment, and limited access to bone marrow transplantation were notable challenges. Intensive chemotherapy resulted in substantial sepsis-related complications, with treatment-related mortality reaching 30%. The 3-year event-free survival and overall survival of the 43 patients who received intensive therapy were 24.5% ± 7.6% and 27.9% ± 8.3%, respectively. Despite these challenges, treating childhood AML was still found to be cost-effective. The total cost per newly diagnosed patient treated with curative intent was $4454. Cost per DALY averted accounted for 24% of the gross domestic product (GDP) per capita, rendering the treatment to be cost-effective with a stringent cost-effectiveness threshold utilized.

CONCLUSION

The study underscores the challenges faced while treating childhood AML in LMICs, including treatment-induced high sepsis-related mortality and abandonment. Despite these challenges, it remains cost-effective to treat childhood AML in India. Future efforts should focus on reducing treatment-related morbidity and mortality to further improve outcomes and cost-effectiveness.