Blood culture time to positivity in oncology pediatric patients / Tiempo de positividad en hemocultivos de pacientes oncológicos pediátricos

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Assessment of anaerobic blood cultures in pediatric oncology patients / Valoración del hemocultivo anaerobio en pacientes oncológicos pediátricos

INTRODUCTION: The routine use of a single aerobic bottle for blood culture in pediatric patients has become commonplace, as anaerobic bacteria are not frequently involved in clinically significant infections. The aim of this study was to assess the usefulness of routinely performing anaerobic blood cultures in pediatric oncology patients. METHODS: Prospective study was conducted on pediatric (<18 years) patients affected with febrile syndrome after receiving chemotherapy for hematological or solid malignancies. Samples were inoculated into pediatric aerobic and standard anaerobic bottles (BacT/Alert automatic system). Strains were considered clinically significant, or deemed as contaminants, depending on isolation circumstances and clinical criteria. RESULTS: A total of 876 blood cultures from 228 patients were processed during the 21-month study period (January 2014 to September 2015). Baseline diagnosis included 143 solid tumors and 67/18 cases of leukemia/lymphoma. Bacterial growth was detected in 90 (10.2%) blood cultures for 95 different isolates, of which 62 (7.1%)/63 isolates were considered clinically significant. Among the latter, 38 (60.3%) microorganisms grew in both aerobic and anaerobic bottles, 18 (28.6%) only in aerobic bottles, and 7 (11.1%) only in anaerobic bottles. Gram-negative bacilli (33; 52.4%), mainly from the Enterobacteriaceae family, were the most frequently isolated microorganisms. Overall, only 3 out of 90 isolates (3.3%) were strict anaerobes (Propionibacterium acnes), and all of them were deemed contaminants. CONCLUSION: Strict anaerobes did not cause significant infections in febrile pediatric oncology patients, and anaerobic blood culture bottles offered no additional advantages over aerobic media. Our results suggest that routine blood cultures should be solely processed in aerobic media in this group of patients

INTRODUCCIÓN: En pacientes pediátricos es habitual el procesamiento de hemocultivos únicamente en medio aerobio, debido a la escasa relevancia de los microorganismos anaerobios en la etiología infecciosa habitual. El objetivo de este estudio es valorar la utilidad del uso rutinario del medio de cultivo anaerobio en pacientes oncológicos pediátricos. MÉTODOS: Estudio prospectivo en pacientes pediátricos (<18años) en tratamiento quimioterápico de procesos oncológicos con síndrome febril. Las muestras se inocularon en botellas aerobias pediátricas y anaerobias estándar (sistema automático BacT/Alert). Las cepas aisladas fueron consideradas clínicamente significativas o contaminantes en función de las circunstancias de aislamiento y la clínica del paciente. RESULTADOS: Durante el periodo de estudio (enero 2015-septiembre 2016) se procesaron 876 hemocultivos procedentes de 228 pacientes diagnosticados de tumores sólidos (143) y leucemia/linfoma (67/18). Se detectó crecimiento en 90 (10,2%) hemocultivos y se aislaron 95 cepas, de los cuales 62 (7,1%), correspondientes a 63 cepas, se consideraron clínicamente significativos. Entre estos últimos, 38 (60,3%) microorganismos crecieron en ambas botellas, 18 (28,6%) únicamente en aerobiosis y 7 (11,1%) únicamente en anaerobiosis. Bacilos gram negativos (33; 52,4%), mayoritariamente enterobacterias, fueron los más frecuentemente aislados. Solo 3 (3,3%) de los microorganismos aislados eran anaerobios estrictos (Propionibacterium acnes), y todos ellos fueron considerados contaminantes. CONCLUSIÓN: Microorganismos anaerobios están raramente involucrados en infecciones en pacientes oncológicos pediátricos, y la utilización de botellas anaerobias no ofrece ninguna ventaja adicional. Según nuestros resultados es suficiente el uso de medio aerobio en el procesamiento de los hemocultivos en este tipo de pacientes

Assessment of anaerobic blood cultures in pediatric oncology patients.

INTRODUCTION: The routine use of a single aerobic bottle for blood culture in pediatric patients has become commonplace, as anaerobic bacteria are not frequently involved in clinically significant infections. The aim of this study was to assess the usefulness of routinely performing anaerobic blood cultures in pediatric oncology patients. METHODS: Prospective study was conducted on pediatric (<18 years) patients affected with febrile syndrome after receiving chemotherapy for hematological or solid malignancies. Samples were inoculated into pediatric aerobic and standard anaerobic bottles (BacT/Alert automatic system). Strains were considered clinically significant, or deemed as contaminants, depending on isolation circumstances and clinical criteria. RESULTS: A total of 876 blood cultures from 228 patients were processed during the 21-month study period (January 2014 to September 2015). Baseline diagnosis included 143 solid tumors and 67/18 cases of leukemia/lymphoma. Bacterial growth was detected in 90 (10.2%) blood cultures for 95 different isolates, of which 62 (7.1%)/63 isolates were considered clinically significant. Among the latter, 38 (60.3%) microorganisms grew in both aerobic and anaerobic bottles, 18 (28.6%) only in aerobic bottles, and 7 (11.1%) only in anaerobic bottles. Gram-negative bacilli (33; 52.4%), mainly from the Enterobacteriaceae family, were the most frequently isolated microorganisms. Overall, only 3 out of 90 isolates (3.3%) were strict anaerobes (Propionibacterium acnes), and all of them were deemed contaminants. CONCLUSION: Strict anaerobes did not cause significant infections in febrile pediatric oncology patients, and anaerobic blood culture bottles offered no additional advantages over aerobic media. Our results suggest that routine blood cultures should be solely processed in aerobic media in this group of patients.

[Neurotoxicity due to methotrexate in paediatric patients. Description of the clinical symptoms and neuroimaging findings]. / Neurotoxicidad por metotrexato en pacientes pediatricos. Descripcion de los sintomas clinicos y hallazgos neurorradiologicos.

INTRODUCTION. High-dose methotrexate (MTX) has showed to increase the surveillance in children with acute lymphoblastic leukemia and other neoplasms. However, MTX may induce significant neurotoxicity. AIM. To evaluate, in our population of patients who have been treated with MTX, the incidence of neurotoxicity and to describe its main clinical and radiological characteristics. PATIENTS AND METHODS. We retrospectively review the patients who received treatment with systemic high-dose MTX and/or intrathecal MTX between 1994 and 2010. The children who presented clinical o radiological signs of neurotoxicity were reviewed. RESULTS. We identified 284 patients who received high-dose intravenous and/or intrathecal MTX. 9 patients presented neurotoxicity. The median age at diagnosis was 6 years; 6 patients were male. The diagnosis included: 6 acute lymphoblastic leukemia, 2 medulloblastoma and 1 lymphoma. 66% patients presented focal neurological dysfunction, 3 had non-specific symptoms. In 5 patients the symptomatology started the first 14 days after the MTX administration. 8 patients had complete clinical resolution, but only one presented neurological long term effects. All the patients except one showed signs of acute leukoencephalopathy in the brain MR study. These alterations resolved one year later in 3 patients; in the other patients the MR alterations persisted. The neurotoxicity management was corticosteroid, folinic acid, aminophylline and dextromethorphan. CONCLUSION. The MTX neurotoxicity it can present as acute or chronic. It has a wide clinical spectrum, ranging from sub-clinical manifestations with complete recovery to a chronic and progressive encephalopathy.