Blood stream infections in pediatric cancer patients, epidemiology and outcome analysis

Abstract EN

Background : knowledge of the pattern of blood stream infections (BSI) in pediatric oncology patients can help determine factors governing these infections, hence antibiotic prescription policy and infection control procedures.

Ultimately, quality preventive and quality management programs are targeted in our institution.

Patients and methods : survey of BSI in pediatric oncology units at the National Cancer Institute (NCI), Cairo University, over 12 months amounted to 328 episodes of bacteremia and fungemia in 250 children with cancer.

Results : A total of 328 BSI occurred in 1135 febrile episodes in pediatric cancer patients at NCI during 1999.

Hospital acquired infections (HAI) contributed to 37.5 % of these episodes.

Gram-positive pathogens were isolated in 168 episodes (51.2 %) and 59 % of the total isolates (either single or mixed), Gram-negative in 97 (29.6%) and mixed infections in 45 (13.7%).

The common causative agents of blood stream infections in the present study were coagulase negative Staphylococci (Co NS) (16.2 %), Staphylococcus aureus (S.

aurous) (13.4 %), Streptococcus spp.

(12.1 %), followed by Acinetobacter spp.

(6.7 %) and Pseudomonas spp (5.5%).

The present study revealed that determinants of a more serious blood stream infection in pediatric oncology patients included hospitalization at time of diagnosis of febrile episode with prolonged hospital stay, intensified chemotherapeutic protocols, prolonged neutropenia, lower respiratory tract infections and multiple coexisting organisms.

The same criteria can be used as prognostic features of blood stream infectious episodes with the addition of fungemia and state of disease, as uncontrolled cancer and induction phase of acute leukemia.

Conclusions: More understanding of the importance of a quality infection control policy with a close surveillance system aiming at early detection of outbreaks, early detection of newly emerged resistant pathogens, presence of isolation systems, strict antibiotic policy and continuous evaluation of the antimicrobial therapy practice are all needed to control the high rates of antibiotic resistance encountered at our institution.