Abstract
BackgroundPediatric cancer patients face an increased risk of healthcare-associated infection (HAI). To date, no prospective multicenter studies have been published on this topic.MethodsProspective multicenter surveillance for HAI and nosocomial fever of unknown origin (nFUO) with specific case definitions and standardized surveillance methods.Results7 pediatric oncology centers (university facilities) participated from April 01, 2001 to August 31, 2005. During 54,824 days of inpatient surveillance, 727 HAIs and nFUOs were registered in 411 patients. Of these, 263 (36%) were HAIs in 181 patients, for an incidence density (ID) (number of events per 1,000 inpatient days) of 4.8 (95% CI 4.2 to 5.4; range 2.4 to 11.7; P < 0.001), and 464 (64%) were nFUO in 230 patients. Neutropenia at diagnosis correlated significantly with clinical severity of HAI. Of the 263 HAIs, 153 (58%) were bloodstream infections (BSI). Of the 138 laboratory-confirmed BSIs, 123 (89%) were associated with use of a long-term central venous catheter (CVAD), resulting in an overall ID of 2.8 per 1,000 utilization days (95% CI 2.3 to 3.3). The ID was significantly lower in Port-type than in Hickman-type CVADs. The death of 8 children was related to HAI, including six cases of aspergillosis. The attributable mortality was 3.0% without a significant association to neutropenia at time of NI diagnosis.ConclusionOur study confirmed that pediatric cancer patients are at an increased risk for specific HAIs. The prospective surveillance of HAI and comparison with cumulative multicenter results are indispensable for targeted prevention of these adverse events of anticancer treatment.
Highlights
Pediatric cancer patients face an increased risk of healthcare-associated infection (HAI)
We present the results of the multicenter prospective surveillance study for HAI and nosocomial fever of unknown origin in 7 German pediatric oncology centers from 2001 through 2005
Basic Data including Device Utilization Seven pediatric oncology centers, all located at tertiary care university facilities, and denoted as C1 to C7, participated in this study for at least 6 consecutive months from April 01, 2001 to August 31, 2005
Summary
Pediatric cancer patients face an increased risk of healthcare-associated infection (HAI). Pediatric cancer patients have an increased risk of potentially life-threatening infectious [1,2,3,4] complications due to their underlying illnesses and intensive anticancer treatment [5,6,7]. Most of these infections are bloodstream infections (BSIs), most often associated with a central venous access device (CVAD) [8]. Healthcare-associated infections (HAIs) in pediatric cancer patients have been investigated in only a few single-center studies [9,10,11,12]. One recent single-center study found an ID of 38.9 HAIs per 1,000 inpatient days in a pediatric stem-cell and bone-marrow transplantation unit [12], but the corresponding protocol referred only to patients with neutropenia [15]
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