Paediatric cancer patients with severe sepsis or septic shock at the PICU with positive microbiological results do worse than those with negative results: a retrospective cohort study

Purpose
Infections are a leading cause of mortality and morbidity in paediatric cancer patients. The aim of this study was to determine whether positive or negative microbiological results impact the clinical outcomes of sepsis in paediatric cancer patients admitted to the paediatric intensive care unit (PICU).

Methods
We performed a retrospective observational single-centre cohort study between 1 January 2018 and 31 December 2020 in the Netherlands. All paediatric cancer patients aged 0 to 18 years admitted to PICU due to severe sepsis or septic shock were included.

Results
We identified 73 PICU admissions in 58 unique patients. Forty-nine of the 73 PICU admissions (67.1%) had positive blood and/or bronchoalveolar lavage microbiological results. Patients with positive results had a higher Paediatric Logistic Organ Dysfunction-2 (PELOD-2) score at PICU admission compared to patients with negative results (median (IQR), 7 (6–9) vs 6 (4–8), p = 0.04). Mortality in PICU among patients with positive results was significantly higher when compared to patients with negative results, 18% versus 0% respectively (p = 0.03). In addition, patients with positive results had significantly less ventilator-free days at day 28 compared to patients with negative results, median (IQR) 26 (19–28) versus 28 (27–28) respectively (p = 0.01).

Conclusions
Microbiologically confirmed infections (bacterial, viral, or fungal) in paediatric cancer patients with sepsis are associated with higher mortality in PICU and a higher need for PICU resources. Large-scale (multicentre) studies in paediatric oncologic patients are required to confirm these results.