[Bloodstream infections in children with cancer and high risk fever and neutropenia episodes in six hospitals of Santiago, Chile between 2004 and 2009]

INTRODUCTION

To determine the etiology of invasive bacterial infection in high risk febrile neutropenia (HRFN) episodes in children with cancer is essential because of the favorable impact on mortality of the early empiric antibiotic treatment.

OBJECTIVE

To determine the etiology of bacteremia in pediatric patients with cancer and HRFN in the National Child Program of Antineoplastic Drugs during the 2004-2009 period, and compare these agents and their antimicrobial susceptibility with the period 1994-1998 described in a previous study.

METHODS

The causative agents of bacteremia were prospectively recorded in patients less than 18 years of age receiving chemotherapy for cancer with HRFN and positive blood cultures admitted to one of the six hospitals from the Child Program of Antineoplastic Drugs network during the period 2004-2009.

RESULTS

839 episodes of HRFN were identified; 181 blood cultures were positive in the following proportion: gram positive cocci (56%), gram negative bacilli (42%) and yeast (2%).The most common etiologic agents were Staphylococcus coagulase negative (25%), Escherichia. coli (20%), group viridans Streptococcus (14%), Staphylococcus aureus (13%) and Pseudomonas aeruginosa (9%). Comparing the two periods, the relative frequency of Streptococcus spp increased from 4 to 17%, coagulase negative Staphylococcus decreased from 44 to 25%, showing an increase in their resistance to oxacillin from 55% to 77%.

CONCLUSIONS

We describe the main etiological agents from HRFN episodes in children with cancer in a 5 years period. This information could help for a better approach in the empirical antimicrobial therapy in this population.

[Adherence to immunization among children with special health care needs]

The proportion of children with special health care needs (CSHCN) due to chronic illness is increasing. They have a high risk of complications due to infectious diseases.

OBJECTIVE

To describe adherence to the Expanded Program of Immunization (EPI) and administration of other expert recommended vaccines in CSHCN.

PATIENTS AND METHODS

In a retrospective manner information on chronic disease, EPI vaccines administration, reasons for delays, prescription and administration of additionally recommended vaccines was registered in a cohort of hospitalized CSHCN.

RESULTS

Seventy children were analyzed. Thirty (42.9%) had at least one delay in EPI immunization schedule; 40% due to previous hospitalizations, 26.7% due to minor morbidity and 20% due to other unjustified reasons. Forty-nine (70.0%) received prescriptions for additional vaccines, but only 25 actually received them.

CONCLUSIONS

CSHCN showed low adherence to EPI and received few additionally recommended vaccines. Every contact with these patients, including hospitalization should be used to update immunizations.