Prediction of attributable mortality in pediatric patients with cancer admitted to the intensive care unit for suspected infection: A comprehensive evaluation of risk scores.

OBJECTIVE: To evaluate the performance of existing sepsis scores for prediction of adverse outcomes in children with cancer admitted to the ICU with suspected sepsis. DESIGN: Retrospective chart review using data available at 1, 6, 12, and 24 h after ICU admission to calculate the Pediatric Risk of Mortality 3 (PRISM-3), Pediatric Sequential Organ Failure Assessment (pSOFA), Paediatric Logistic Organ Dysfunction 2 (PELOD-2), and Quick Pediatric Sequential Organ Failure Assessment (qSOFA) scores. Area under the receiver operator characteristic curve (AUROC) was used to evaluate performance for prediction of attributable mortality. Sensitivity analyses included recalculation of scores using worst preceding values for each variable, excluding hematologic parameters, and prediction of alternative outcomes. SETTING: St. Jude Children's Research Hospital, a pediatric comprehensive cancer center in the USA. PATIENTS: Pediatric patients (<25 years of age) receiving conventional therapy for cancer admitted to the ICU with suspected sepsis between 2013 and 2019. RESULTS: Of 207 included episodes of suspected sepsis, attributable mortality was 16 (7.7%) and all evaluated sepsis scores performed poorly (maximal AUROC of 0.73 for qSOFA at 1 and 24 h). Sensitivity analyses did not identify an alternative approach that significantly improved prediction. CONCLUSIONS: Currently available sepsis scores perform poorly for prediction of attributable mortality in children with cancer who present to ICU with suspected sepsis. More research is needed to identify reliable predictors of adverse outcomes in this population.

A Case of New Delhi Metallo-ß-Lactamases (NDM) Citrobacter sedlakii Osteomyelitis Successfully Treated With Ceftazidime-Avibactam and Aztreonam.

There have been an increase in multi-drug resistant (MDR) organisms causing infections with high mortality and morbidity. Bacteria that carry metallo-ß-lactamases (MBLs) are particularly dangerous. Novel antibiotic combinations, such as ceftazidime-avibactam with aztreonam, are in clinical trials for the treatment of MBL-harboring bacteria. We discuss the case of a 39-year-old patient who presented with tibial osteomyelitis growing MBL-producing Citrobacter sedlakii. He was successfully treated with ceftazidime-avibactam and aztreonam combination therapy. We discuss the importance of developing new antibiotic regimens for the growing threat of MDR organisms with special consideration of MBL.