Burden of sepsis in critically ill children with cancer: A retrospective study

• Published in: Journal of critical care 2024-06, Vol.81, p.154599, Article 154599
• Main Authors: Sharma, Sudivya, Bhosale, Shilpushp, Kulkarni, Atul, Divatia, Jigeeshu, Dhamne, Chetan
• Format: Article
• Language: English
• Subjects: Antimicrobial agents; Cancer; Children; Critically ill; Drug resistance; Intensive care; Mortality; Pediatrics; Sepsis
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154599

The mortality of pediatric intensive care unit is 27.8% globally and its even higher, i.e. 46.2% in children with sepsis. Children with cancer suffer higher incidence as well as severity of sepsis. Five-year survival of children with cancer has tremendously improved to 83% and two thirds of them require at least one intensive care admission throughout their disease course. Sepsis is the commonest cause of admission and death in intensive care (ICU). We aim to review mortality in critically ill children with cancer with respect to sepsis and its causative microorganisms. We retrospectively studied all pediatric admissions to ICU during the period from 1st January 2022 to 31st December 2022 in a tertiary cancer hospital in Mumbai, India. The primary outcome was ICU mortality in this cohort and secondary outcomes included proportion of children admitted with sepsis, suspected source of sepsis, culture results with special focus on ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, Enterobacter species). Over a period of 12 months, 386 children (0–18 years) had 513 admissions in our ICU, with 138 girls (35.8%) and 248 males (64.2%). The ICU mortality was 22.5%. Two hundred and twenty four (58%) patients were admitted with sepsis, out of which 82 patients had culture positive results in one or more samples such as blood, bronchoalveolar lavage, cerebrospinal fluid, etc. The ESKAPE organisms constituted most of the culture isolates with Escherichia coli being the most common, followed by Klebsiella and Pseudomonas. Nearly half of the children (42/82) with positive culture results died as opposed to one fourth mortality in children with culture negative results (32/141). The gram-negative bacilli exhibited a high incidence of carbapenem resistance. Overall incidence of gram-positive infections was low. Viral and fungal infections were diagnosed more clinically or radiologically, or using molecular testing, serum biomarkers as opposed to culture testing. Sepsis with ESKAPE organism is a major concern in critically ill children with cancer. The high mortality and rising antimicrobial resistance demand focus on tailoring research to improve outcomes in this patient population. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629–655. doi: https://doi.org/10.1016/S0140-6736(21)0272