McCullers JA, Williams BF, Wu S, Smeltzer MP, Williams BG, Hayden RT, Howard SC, Pui CH, Hughes WT. Healthcare-Associated Infections at a Children's Cancer Hospital, 1983-2008.
J Pediatric Infect Dis Soc 2012;
1:26-34. [PMID:
23687571 PMCID:
PMC3656547 DOI:
10.1093/jpids/pis034]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 01/25/2012] [Indexed: 11/13/2022]
Abstract
BACKGROUND
Little is known about the incidence and etiology of healthcare-associated infections in immunosuppressed children.
METHODS
Data collected prospectively between 1983 and 2008 were used to analyze changes in the rate, types of infection, and infecting organisms over time in patients treated at a children's cancer hospital. Neutropenia was evaluated as a risk factor.
RESULTS
Over the 26-year study period, 1986 healthcare-associated infections were identified during 1653 hospitalizations. The infection rate decreased significantly from 5.6 to 2.0 infections per 100 discharges (P < .01) and from 9.0 to 3.7 infections per 1000 patient-days (P < .01). Bloodstream infections were the most common type of infection (32.7% of all infections). Staphylococci (46.4% of Gram-positive bacteria), Escherichia coli (36.7% of Gram-negative bacteria), and Candida spp. (68.7% of fungi) were the most common pathogens isolated. An absolute neutrophil count (ANC) nadir <100 per mm(3) was significantly associated (P < .0001) with an increased rate of infections compared with higher ANC nadirs.
CONCLUSIONS
Despite a steady expansion in hospital capacity and patient encounters over the last 3 decades, rates of healthcare-associated infections decreased significantly at our hospital. These data suggest that sustained decreases in the rate of healthcare-associated infections in immunosuppressed children are possible. An ANC <100 per mm(3) is a risk factor for healthcare-associated infections in this population.
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