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2 results on '"Sepsis / epidemiology"'

1. 39·0°C versus 38·5°C ear temperature as fever limit in children with neutropenia undergoing chemotherapy for cancer: a multicentre, cluster-randomised, multiple-crossover, non-inferiority trial

Author

David Nadal, Jochen Roessler, Cécile Adam, Kurt Leibundgut, Marc Ansari, Katrin Scheinemann, Felix Niggli, Michael Zeller, Karin Zimmermann, Oliver Teuffel, Nanette Keller, Roland A. Ammann, Philipp Agyeman, Christa Koenig, Nicolas von der Weid, Bernhard Eisenreich, Nicole Bodmer, Arne Simon, University of Zurich, and Ammann, Roland A

Subjects
Male, Pediatrics, medicine.medical_treatment, Bacteremia, Rate ratio, law.invention, Body Temperature, Patient Admission, 0302 clinical medicine, law, Neoplasms, Developmental and Educational Psychology, Medicine, Blood culture, 030212 general & internal medicine, Prospective Studies, Child, 610 Medicine & health, ddc:618, Cross-Over Studies, Neoplasms / therapy, medicine.diagnostic_test, Ear, Intensive care unit, Patient Admission / statistics & numerical data, Child, Preschool, Female, medicine.drug, medicine.medical_specialty, Febrile Neutropenia / diagnosis, Adolescent, Antineoplastic Agents, Neutropenia, Intensive Care Units, Pediatric, Bacteremia / epidemiology, 03 medical and health sciences, Sepsis, 030225 pediatrics, Humans, Antipyretic, 2735 Pediatrics, Perinatology and Child Health, Febrile Neutropenia, Chemotherapy, 3204 Developmental and Educational Psychology, business.industry, Antineoplastic Agents / therapeutic use, Interim analysis, medicine.disease, Sepsis / epidemiology, Transplantation, 10036 Medical Clinic, Pediatrics, Perinatology and Child Health, business
Abstract

BACKGROUND Fever in neutropenia is the most frequent complication of chemotherapy for cancer. The temperature limit defining fever used clinically varies. A higher limit can avoid unnecessary diagnoses in patients spontaneously recovering from fever. This trial primarily aimed to determine if a limit of 39·0°C ear temperature is non-inferior to 38·5°C regarding safety. METHODS This cluster-randomised, multiple crossover, non-blinded, non-inferiority trial was done in six Swiss Paediatric Oncology Group centres (clusters) in Switzerland. Patients (aged 1 to

Published
2020
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2. Epidemiology and complications of late-onset sepsis: an Italian area-based study

Author

Laura Lucaccioni, M. G. Capretti, Matilde Ciccia, Marcello Lanari, Crisoula Tzialla, Caterina Spada, Lorenza Baroni, Francesca Sforza, Claudia Venturelli, Vittoria Rizzo, Alberto Berardi, Giacomo Biasucci, Edoardo Carretto, Simone Ambretti, Maria Federica Pedna, Serenella Bolognesi, Maria Letizia Bacchi Reggiani, and Alberto Berardi, Francesca Sforza, Lorenza Baroni, Caterina Spada, Simone Ambretti, Giacomo Biasucci, Serenella Bolognesi, Mariagrazia Capretti, Edoardo Carretto, Matilde Ciccia, Marcello Lanari, Maria Federica Pedna, Vittoria Rizzo, Claudia Venturelli, Crisoula Tzialla, Laura Lucaccioni, Maria Letizia Bacchi Reggiani

Subjects
Male, Pediatrics, Databases, Factual, Physiology, Nosocomial Infections, Pathology and Laboratory Medicine, Group B, Gram-Positive Bacteria / pathogenicity, 0302 clinical medicine, Catecholamines, Retrospective Studie, Infectious Diseases of the Nervous System, Risk Factors, Medicine and Health Sciences, Birth Weight, 030212 general & internal medicine, Fungal Pathogens, Multidisciplinary, Neonatal sepsis, Fungi / isolation & purification, Gestational age, Sepsis / etiology, 3. Good health, Bacterial Pathogens, Body Fluids, Gram-Negative Bacteria / pathogenicity, Infectious Diseases, Blood, Physiological Parameters, Neurology, Italy, Premature birth, Medical Microbiology, Premature Birth, Medicine, Female, medicine.symptom, Pathogens, Neonatal Sepsis, Anatomy, Meningitis, Research Article, medicine.medical_specialty, Birth weight, Meningitis / diagnosi, Inflammatory Diseases, Science, Gestational Age, Mycology, Gram-Positive Bacteria, Microbiology, Meningitis / microbiology, Sepsis, 03 medical and health sciences, Signs and Symptoms, Diagnostic Medicine, 030225 pediatrics, Fungi / pathogenicity, Gram-Negative Bacteria, medicine, Humans, Gram-Negative Bacteria / isolation & purification, Microbial Pathogens, Retrospective Studies, business.industry, Body Weight, Fungi, Infant, Newborn, Biology and Life Sciences, Neonates, Infant, Sepsis / diagnosi, medicine.disease, Respiration, Artificial, Sepsis / epidemiology, Low birth weight, Catecholamines / administration & dosage, Gram-Positive Bacteria / isolation & purification, business, Meningitis / complication, Sepsis / mortality, Developmental Biology
Abstract

BackgroundMost studies regarding late-onset sepsis (LOS) address selected populations (i.e., neonates with low birth weight or extremely preterm neonates). Studying all age groups is more suitable to assess the burden of single pathogens and their clinical relevance.MethodsThis is a retrospective regional study involving paediatric departments and NICUs in Emilia-Romagna (Italy). Regional laboratory databases were searched from 2009 to 2012. Records of infants (aged 4 to 90 days) with a positive blood or cerebrospinal fluid (CSF) culture were retrospectively reviewed and analysed according to acquisition mode (whether hospital- or community-acquired).ResultsDuring the study period, there were 146,682 live births (LBs), with 296 patients experiencing 331 episodes of LOS (incidence rate: 2.3/1000 LBs). Brain lesions upon discharge from the hospital were found in 12.3% (40/296) of cases, with death occurring in 7.1% (23/296; 0.14/1000 LBs). With respect to full-term neonates, extremely preterm or extremely low birth weight neonates had very high risk of LOS and related mortality (> 100- and > 800-fold higher respectively). Hospital-acquired LOS (n = 209) was significantly associated with very low birth weight, extremely preterm birth, pneumonia, mechanical ventilation, and death (p< 0.01). At multivariate logistic regression analysis, catecholamine support (OR = 3.2), central venous line before LOS (OR = 14.9), and meningitis (OR = 44.7) were associated with brain lesions or death in hospital-acquired LOS (area under the ROC curve 0.81, H-L p = 0.41). Commonly identified pathogens included coagulase-negative staphylococci (CoNS n = 71, 21.4%), Escherichia coli (n = 50, 15.1%), Staphylococcus aureus (n = 41, 12.4%) and Enterobacteriaceae (n = 41, 12.4%). Group B streptococcus was the predominant cause of meningitis (16 of 38 cases, 42%). Most pathogens were sensitive to first line antibiotics.ConclusionsThis study provides the first Italian data regarding late-onset sepsis (LOS) in all gestational age groups. Compared to full-term neonates, very high rates of LOS and mortality occurred in neonates with a lower birth weight and gestational age. Group B streptococcus was the leading cause of meningitis. Excluding CoNS, the predominant pathogens were Escherichia coli and Staphylococcus aureus. Neonates with hospital-acquired LOS had a worse outcome. Antibiotic associations, recommended for empirical treatment of hospital- or community-acquired LOS, were adequate.

Published
2019

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