BACTEREMIA AND FUNGEMIA IN PEDIATRIC VERSUS ADULT CANCER-PATIENTS AFTER CHEMOTHERAPY - COMPARISON OF ETIOLOGY, RISK-FACTORS AND OUTCOME

One hundred and eighteen (118) episodes of bacteremia and fungemia in children with cancer were compared to 401 episodes of bacteremia and f ungemia in adults with cancer;to assess differences in etiology, risk factors and outcome. A retrospective univariate analysis was performed of all episodes of bacteremia in national pediatric and adult cancer institutions appearing in 1990-1996. A total of 519 episodes of bacter emia were assessed and compared. Both cancer centers differed in proph ylactic antibiotic policies. About 50% of adults but less than 5% of c hildren received quinolone prophylaxis during neutropenia, even though the empiric antibiotic therapeutic strategy was similar. There were d ifferences in etiology between the groups: staphylococci and Stenotrop homonas maltophilia were more frequently observed in children (P<0.01) , Pseudomonas aeruginosa and Acinetobacter spp, in adults (P<0.05). Gr am-positive bacteremia was surprisingly more commonly observed in adul ts (65.7% vs 33.3%, P<0.01). Mixed polymicrobial bacteremia occurred m ore commonly in adults (31.8% vs 7.6%, P<0.001) than in children. Anal ysis of risk factors did not observe differences in risk factors excep t for underlying disease (acute leukemia was more frequently observed in children - 48.3% vs adults 33,7%, P<0.05 and prophylaxis: (prior pr ophylaxis with quinolones was more common in adults (47.5%) than in ch ildren (2.5%) P<0.0001). Overall and attributable mortality in pediatr ic bacteremia was significantly lower than in adults (P<0.03).