#29: Analysis of Mortality Due to Infections in Pediatric Patients in the Oncology Unit of a Third Level Hospital in La Paz, Bolivia

Abstract

Abstract Background In recent decades, advances in cancer treatment have made it possible to improve the prognosis of hemato-oncological patients, however, mortality is still high in developing countries. One of the most important causes of morbidity and mortality during the treatment of children with cancer is infectious complications, especially in the induction phase. The multiple interventions that are carried out during treatment, such as the use of catheters, increase the risk of developing these infections, which can be more frequent if the recommended strategies to prevent them are not applied. The objective of this study was to investigate what were the causes of death in children with cancer at our institution. Methods The medical records of deceased patients were analyzed in the onco-hematology unit of the Children′s Hospital “Dr. Ovidio Aliaga Uria” in the city of La Paz, Bolivia. The causes of mortality, the stage of chemotherapy in which the death occurred, its relationship with infections and the microorganism identified during 2020 were classified. Results During 2020, 19 deaths were found in cancer patients, the mean age was 8.5 years and of which 52% were male. Regarding the basic diagnosis, there was a higher proportion of hematological diseases 68% and solid tumors 32%. Among the causes of death, 58% were due to their underlying pathology where most of the patients were in palliative care or in relapse and 42% were due to infectious causes, of which 62% were in induction phase of chemotherapy. Among the 8 patients who died from infections, the following causes were found: 50% neutropenic colitis, 25% bacteremia and 25% necrotizing fasciitis; in 7 (87.5%) patients the microorganism was isolated in blood culture, these were E. coli 43%, Klebsiella spp 43% and Bacillus spp 14%. Gram negative bacilli (GNB) represented 86% of the isolates and 50% were producers of extended spectrum beta-lactamases (ESBL). Conclusions Considering that infections are preventable and are among the most important causes of mortality in children with cancer in our hospital, it is essential that infection control teams are developed that apply evidence-based strategies to prevent these infections and thus achieve a reduction in morbidity and mortality, applying programs with training of human resources and equipment to reduce these deaths.