A prospective study of septicaemia on a paediatric oncology unit: a three-year experience at The Royal Liverpool Children’s Hospital, Alder Hey, UK.
Paulus SC., van Saene HK., Hemsworth S., Hughes J., Ng A., Pizer BL.
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.