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Septicaemia in neutropaenic patients is predominantly due to gut translocation [endogenous septicaemia] and contamination of the central venous catheter by microorganisms not carried by the patient [exogenous septicaemia]. To control both types of infection, a protocol was implemented based on pre 1990’s parenteral and enteral antimicrobials together with strict hygiene. Surveillance cultures of throat/rectum were taken to distinguish exogenous from endogenous septicaemia and enteral non-absorbable antibiotics are administered as part of selective decontamination of the digestive tract (SDD). This protocol was evaluated in a 14-bedded paediatric oncology unit over a period of 3 years. 313 Septicaemia episodes were recorded in 131 children. 28.4% of the septicaemias were caused by microorganisms associated with the unit, equivalent to 0.82 episodes per 100 patient days. Low-level pathogens such as coagulase-negative staphylococci caused more than 70% of infections. Amongst the potential pathogens, Pseudomonas species (7.8%) and Staphylococcus aureus (5.5%) were predominant. Antibiotic resistance was rare with no superinfections or outbreaks. Four patients (3%) died, two due to Candida species and two due to Pseudomonas aeruginosa. We believe that the addition of enteral non-absorbable antibiotics to systemic antibiotics maintained a low level of resistance and mortality but a randomised controlled trial is indicated to confirm these observations.

Original publication

DOI

10.1016/j.ejca.2005.04.037

Type

Journal article

Journal

European journal of cancer (Oxford, England : 1990)

Publication Date

09/2005

Volume

41

Pages

2132 - 2140

Addresses

Department of Paediatric Oncology, The Royal Liverpool Children’s Hospital, Eaton Road, Liverpool L12 2AP, United Kingdom.

Keywords

Humans, Cross Infection, Sepsis, Neoplasms, Antineoplastic Agents, Immunosuppressive Agents, Anti-Bacterial Agents, Prospective Studies, Infection Control, Drug Resistance, Adolescent, Child, Child, Preschool, Hospitals, Pediatric, England, Female, Male