Incidence of septicaemias and invasive mycoses in children undergoing treatment for solid tumours: a 12-year experience at a single Italian institution R. Haupt a,b , M. Romanengo b , T. Fears c , C. Viscoli d , E. Castagnola e, * a Scientific Directorate, Clinical Epidemiology and Biostatistics Section, Gaslini Children’s Hospital, Genova, Italy b Hematology/Oncology Unit, Gaslini Children’s Hospital, Genova, Italy c Biostatistics Branch, National Cancer Institute, NIH, Bethesda, MD, USA d The University of Genoa, and the Immunocompromised Host Disease Unit of the National Institute for Cancer Research, Genova, Italy e Infectious Diseases Unit, G. Gaslini Children’s Hospital, Genova, Italy Received 27 September 2000; received in revised form 25 June 2001; accepted 7 August 2001 Abstract We carried out a retrospective study on the infection rate—in episodes per 100 person months at risk (p/m/r)—of septicaemia and invasive mycoses in children with solid tumours treated at a single institution between 1985 and 1996. Among 982 patients, accounting for 8108 p/m/r, 257 infectious episodes were documented, for an infection rate of 3.2. The infection rate for ‘intensive’ treatment was greater than that for ‘less intensive’ treatments, 3.7 compared with 0.5, respectively; P < 0.001. 58% of infectious episodes were associated with neutropenia, 22% were megatherapy-related, and 39% were related to central venous catheter (CVC), while in 13% of the episodes no risk factor was identified. Of the episodes, single organism Gram-positive bacteraemias accounted for 62%, single organism Gram-negative for 23%, multiple organism bacteraemias for 7%, invasive mycoses for 4%, and isolated fungaemias for 4%. The infection rate for Gram-positive organisms decreased significantly over time (5.9% per year; P < 0.01), but increased for the Gram-negative organisms (+3.4% per year; P=0.4). This study demonstrates that the risk of bacteraemia increases in parallel with the treatment intensity, and that a considerable number of children with solid tumours develop bacter- aemia in the absence of an identifiable risk factor. # 2001 Elsevier Science Ltd. All rights reserved. Keywords: Bacterial infections; Mycoses; Paediatrics; Solid tumour 1. Introduction Infections are an important cause of morbidity and mortality for patients undergoing treatment for cancer [1]. The incidence of infection may vary between insti- tutions because of different prophylactic measures and treatment protocols. Since the risk of infection in cancer patients is multifactorial [2] and is present throughout the entire treatment period, the incidence of severe infectious complications should be evaluated during the entire period of treatment of each patient. Most of the dataonthistopicderivefromstudiesfocusedonspecific risk factors, e.g. febrile neutropenia [3–5], the use of indwelling central venous catheters (CVC) [6–11], megatherapy with autologous bone marrow or peri- pheral staminal cells rescue [12,13], oncological surgery [14–16], or antibiotic therapy of febrile neutropenia [17– 22]. These data are rarely generated from prospective studies, but usually extrapolated from other studies, e.g. randomised clinical trials of empirical antibiotic therapy for febrile neutropenia. Such studies use only a subset of the population of cancer patients, i.e. only those eligible for the trial, so the overall prevalence estimates do not necessarily represent the entire patient population. Moreover, because of conventional methods of trial reporting, second or third episodes occurring in the same patient are generally missed, leading to an under- estimate of the overall infection rates. Only two studies have reported the epidemiology of infectious complications in children with cancer using data from a single centre during the entire course of 0959-8049/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved. PII: S0959-8049(01)00274-X European Journal of Cancer 37 (2001) 2413–2419 www.ejconline.com * Corresponding author. Tel.: +39-010-563-6428; fax: +39-010- 377-6590. E-mail address: eliocastagnola@ospedale-gaslini.ge.it (E. Castagnola).