Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients

  • Haichen Wang Department of Clinical Laboratory, Xiangya Hospital, Central South University, Kaifu District, Changsha, Hunan, China
  • Jianling Liu Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Ziyan Huang Department of Clinical Laboratory, Xiangya Hospital, Central South University, Kaifu District, Changsha, Hunan, China
  • Xiaoyan Tao Department of Clinical Laboratory, Xiangya Hospital, Central South University, Kaifu District, Changsha, Hunan, China
  • Jun Li Department of Clinical Laboratory, Xiangya Hospital, Central South University, Kaifu District, Changsha, Hunan, China
  • Yongmei Hu Department of Clinical Laboratory, Xiangya Hospital, Central South University, Kaifu District, Changsha, Hunan, China
  • Qingya Dou Department of Infection Control Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
  • Mingxiang Zou Department of Clinical Laboratory, Xiangya Hospital, Central South University, Kaifu District, Changsha, Hunan, China
  • Qun Yan Department of Clinical Laboratory, Xiangya Hospital, Central South University, Kaifu District, Changsha, Hunan, China
  • Wen' en Liu Department of Clinical Laboratory, Xiangya Hospital, Central South University, Kaifu District, Changsha, Hunan, China
Keywords: Escherichia coli bacteremia, hematological disorders, shock, mortality, risk factors

Abstract

Introduction: The aim of our study was to evaluate the epidemiology, clinical features and risk factors for shock and mortality from Escherichia coli bacteremia among children and adolescents with hematological disorders.

Methodology: A retrospective observational study of E. coli bacteremia in the hematology department at Xiangya Hospital from January 2013 to June 2018 was conducted. Clinical characteristics, laboratory results and antimicrobial susceptibility were analysed. Risk factors for shock and mortality were also investigated.

Results: Of the 45 strains of E. coli, 73.3% were multidrug-resistant (MDR). Septic shock was observed in 51.1% of patients, and the 30-day all-cause mortality was 22.2%. The risk factors associated with shock were an elevated red blood cell distribution (RDW) value when bloodstream infections (BSIs) occurred (> 15%, OR, 6.840; 95% CI, 1.571 – 29.788) and a lower WBC count (< 300/mm3, OR, 6.761; 95% CI, 1.383 – 33.044). Multivariate analysis showed that only an elevated D-dimer level (> 0.5 mg/L, OR 12.250, 95% CI 1.268 – 118.361) was a risk factor for 30-day mortality. Furthermore, we observed decreases for RDW changes at two time points (neutropenia and BSIs occurred) in the non-shock group and survival group.

Conclusions: MDR infections from E. coli bacteremia were common in pediatric hematological patients. In our setting, the laboratory results may serve as a clue for physicians to distinguish patients at higher risk for shock and mortality. Furthermore, RDW could be used as a biomarker to elucidate potential disorders in hematological patients.

Published
2019-05-31
How to Cite
1.
Wang H, Liu J, Huang Z, Tao X, Li J, Hu Y, Dou Q, Zou M, Yan Q, Liu W en (2019) Clinical characteristics and risk factors for shock and death from E. coli bacteremia in pediatric hematological patients. J Infect Dev Ctries 13:365-373. doi: 10.3855/jidc.11099
Section
Original Articles