PSEUDOMONAS-AERUGINOSA BACTEREMIA IN IMMUNOCOMPROMISED CHILDREN - ANALYSIS OF FACTORS ASSOCIATED WITH A POOR OUTCOME

We identified 98 children and adolescents with cancer who were treated for Pseudomonas aeruginosa bacteremia over a 27-year period. The most common underlying disease was leukemia (lymphoblastic in 63 cases and myeloblastic in 17); in addition, 12 episodes were associated with so lid tumors and 6 with other diagnoses. There were 29.5 episodes of P. aeruginosa bacteremia/1,000 cases of acute lymphoblastic leukemia, wit h a mortality of 27%, and 29.8 episodes/1,000 cases of acute myeloblas tic leukemia, with a mortality of 24%; patients with solid tumors had an incidence of 5.0/1,000 cases and a mortality of 58% (P=.01 for mort ality in leukemia vs. mortality in solid tumors, logistic regression a nalysis). Mortality was lower among children who developed bacteremia during remission therapy or induction therapy than among children who were being treated for relapse (P=.001). The majority (78%) of the 76 evaluated cases developed during periods when the absolute neutrophil count (ANC) was <0.1 X 10(9)/L; mortality was higher among patients wi th such counts than among those with higher ANCs (36% vs. 14%, P=.04). Logistic regression analysis showed that perineal skin lesions were a ssociated with higher mortality than were lesions at other sites of sk in involvement (54% vs. 23%, P=.04).