Voriconazole prophylaxis in children with cancer: changing outcomes and epidemiology of fungal infections.

Background: Invasive mould infections are a significant cause of morbidity and mortality in pediatric cancer patients, particularly in those undergoing aggressive myeloablative chemotherapy. Voriconazole has been described as an appropriate and effective prophylactic agent in adults with cancer.

Methods: We compared the etiology, predisposing factors and outcomes of invasive mould infection in patients treated for acute myeloid leukemia before and after implementation of voriconazole prophylaxis in a pediatric cancer center.

Timeline, epidemiology, and risk factors for bacterial, fungal, and viral infections in children and adolescents after allogeneic hematopoietic stem cell transplantation.

Advances made in the field of hematopoietic stem cell transplantations (HSCT) over the past 20 years may have had an impact on the distribution of posttransplantation infections. We sought to retrospectively analyze the epidemiology and risk factors for bacterial, fungal, and viral infections in children after allogeneic HSCT in a cohort of 759 children who underwent allogeneic HSCT in a single institution between 1990 and 2009. The association between infections and risk factors of interest at 0 to 30 days, 31 to 100 days, and 101 days to 2 years posttransplantation was evaluated using logistic regression.

Ethanol lock therapy in pediatric hematology and oncology.

Central venous catheters are essential for treatment of cancer and hematologic disorders in children. Central line-associated bloodstream infection (CLABSI) is the most common important complication and can lead to serious sequelae. Conventional antibiotic treatment is often unsuccessful.

Diagnostic value of routine chest radiography in febrile, neutropenic children for early detection of pneumonia and mould infections.

Background: Despite recent studies failing to demonstrate the value of routine chest radiography (CXR) in the initial evaluation of the febrile neutropenic patient with cancer, this screening test is advocated by some experts. We evaluated the benefits of CXR for early diagnosis of pulmonary infection at St. Jude Children's Research Hospital (SJCRH) with emphasis on early recognition of mould infections.

Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

Parainfluenza virus infections in children with hematologic malignancies.

Background: Parainfluenza virus (PIV) infections are an important cause of morbidity in children with upper or lower respiratory tract infection (URTI and LRTI, respectively). However, the epidemiology of PIV infections in children with cancer has not been well studied.

Methods: This retrospective study sought to determine the epidemiology of PIV infections and risk factors for progression to an LRTI in 1381 children diagnosed with leukemia or lymphoma, between 2000 and 2009.

Symptomatic parainfluenza virus infections in children undergoing hematopoietic stem cell transplantation.

Parainfluenza virus (PIV) infections cause significant mortality in adults undergoing hematopoietic stem cell transplantation (HSCT). Children are more prone to PIV infections than adults; however, data on the epidemiology of these infections in children undergoing HSCT are limited. This study examined the incidence of symptomatic PIV infections, risk factors for lower respiratory tract infection (LRTI), and the impact on mortality after pediatric HSCT.

Managing fungal and viral infections in pediatric leukemia.

Despite steadily improving long-term outcomes, infections remain a major cause of morbidity and mortality in children receiving therapy for leukemia. Standardized approaches to the management of bacterial infections have been highly successful. However, management of fungal and viral infections remains challenging, especially given the shifting epidemiology of fungal infections.

Increasing prevalence of nasal and rectal colonization with methicillin-resistant Staphylococcus aureus in children with cancer.

Background: Infections with methicillin-resistant Staphylococcus aureus (MRSA), in community-settings, especially with strains carrying the Panton-Valentine Leukocidin (PVL) genes, have increased markedly in recent years. Colonization with S. aureus is a risk factor for infection.

Short communication: methicillin-resistant Staphylococcus aureus infections in children and young adults infected with HIV.

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) infections, in particular with Panton-Valentine leukocidin (PVL)-positive strains, has not been well characterized in children and young adults with HIV infection. It is not known if PVL-positive strains of MRSA cause an increased morbidity in this population compared to PVL-negative strains. The purpose of this study was to retrospectively analyze the epidemiology of PVL-positive and PVL-negative MRSA infections in children and young adults with HIV from 2000 to 2007.

Staphylococcus aureus bacteremia in pediatric patients with cancer.

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S.aureus (MSSA) in children with cancer has not been well studied. A total of 10 MRSA and 42 MSSA isolates from bacteremic episodes were collected from cancer patients from 2000 through 2007.

Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus infections in children with cancer.

Background: New strains of methicillin-resistant Staphylococcus aureus (MRSA) which frequently carry the Panton-Valentine leukocidin (PVL) genes have been recognized to cause invasive infections in otherwise healthy children and adults. However, the epidemiology of PVL-positive MRSA infections has not been described in children or adults with cancer.

Procedure: The epidemiology of MRSA infections in patients with cancer was retrospectively studied from 2000 to 2007.

Cutaneous infection caused by Macrophomina phaseolina in a child with acute myeloid leukemia.

We report a case of Macrophomina phaseolina skin infection in an immunocompromised child with acute myeloid leukemia, which was treated successfully with posaconazole without recurrence after a hematopoietic stem cell transplant. The fungus was identified by DNA sequencing using both the internal transcribed spacer and D1/D2 region of the 28S ribosomal DNA gene.

Prophylactic antibiotics reduce morbidity due to septicemia during intensive treatment for pediatric acute myeloid leukemia.

Background: The aim of this study was to determine whether antibiotic prophylaxis during periods of neutropenia reduced streptococcal (S. viridans) sepsis and overall bacterial sepsis.

Methods: The authors reviewed outcomes of 78 evaluable patients who were consecutively treated for acute myeloid leukemia (AML) from October 2002 through January 2007.

Computer-assisted bar-coding system significantly reduces clinical laboratory specimen identification errors in a pediatric oncology hospital.

Objective: To assess the ability of a bar code-based electronic positive patient and specimen identification (EPPID) system to reduce identification errors in a pediatric hospital's clinical laboratory.

Study Design: An EPPID system was implemented at a pediatric oncology hospital to reduce errors in patient and laboratory specimen identification. The EPPID system included bar-code identifiers and handheld personal digital assistants supporting real-time order verification.

BK virus-induced tubulointerstitial nephritis in a child with acute lymphoblastic leukemia.

We report a case of BK virus-induced tubulointerstitial nephritis in a child with acute lymphoblastic leukemia. Primary BK virus infection was exacerbated by chemotherapy-induced immunodeficiency. Careful administration of chemotherapy and anti-viral therapy prevented further damage.

Diagnosis of catheter-related bloodstream infections among pediatric oncology patients lacking a peripheral culture, using differential time to detection.

Background: Current methods for in situ diagnosis of catheter-related bloodstream infections require concurrent collection of central venous catheter (CVC) and peripheral vein (PV) blood cultures. Both the pain and inconvenience of PV cultures are undesirable.

Methods: A prospective study was conducted (August 2002 to March 2004) to assess the accuracy of diagnosing catheter-related bloodstream infections based on the difference in time to detection of blood cultures drawn concurrently from 2 lumens of a multilumen CVC.

Myositis complicating viridans streptococcal sepsis in childhood leukemia.

Hematogenous focal infections are a rare complication of bacteremia or sepsis caused by viridans-group streptococci. We describe two patients with acute leukemia who developed myositis during alpha-hemolytic streptococcal bacteremia. Children complaining of severe muscle pain associated with viridans streptococcal infections should be carefully evaluated for the presence of focal pyogenic complications and rhabdomyolysis.

Optimum management of pediatric patients with fever and neutropenia.

Fever with neutropenia is a common clinical problem in patients receiving cancer treatment. Prevention and optimum management of infectious complications is critical to the overall success of cancer therapy. This article provides an overview of the current status of this evolving subject.

Safety and immunogenicity of intranasal murine parainfluenza virus type 1 (Sendai virus) in healthy human adults.

Human parainfluenza virus-type 1 (hPIV-1) is the most common cause of pediatric laryngotracheobronchitis (croup) and results in close to 30,000 US hospitalizations each year. No effective vaccine is available. We examined murine PIV-1 (Sendai virus, SeV) as a live, xenotropic vaccine for the closely related human PIV-1 in a phase I, dose escalation study in healthy adults.

In situ diagnosis of central venous catheter-related bloodstream infection without peripheral blood culture.

Background: Catheter-related bloodstream infections (CRBIs) are frequent complications of the use of long term central venous catheters (CVCs). Comparative quantitative culture of blood obtained via the CVC and a peripheral vein (PV) is a well-accepted method of diagnosing CRBI; however, an alternative definition for use when a PV culture is not available is desirable.

Methods: A computerized search of patient records identified all positive blood culture results from the St.

Benefit of surgical resection of invasive pulmonary aspergillosis in pediatric patients undergoing treatment for malignancies and immunodeficiency syndromes.

Purpose: The aim of this study was to evaluate the outcome of children undergoing treatment for malignancy and immunodeficiency syndromes in whom invasive pulmonary aspergillosis (IPA) developed.

Methods: The authors reviewed the medical records of all patients treated at their institution from January 1990 to August 1999 for culture-proven pulmonary aspergillus infection.

Results: Among the 43 patients studied, the median age at the time of diagnosis of IPA was 13.

Viridans streptococcal sepsis: clinical features and complications in childhood acute myeloid leukemia.

Purpose: Treatment of acute myeloid leukemia (AML) is associated with substantial adverse effects, including neutropenia and infection. Viridans streptococci (VS) are a primary cause of infection and pneumonia in patients with neutropenia. The authors determined the incidence, clinical features, and complications of VS sepsis in children receiving chemotherapy for AML.