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Multicenter Study
. 2008 May 23:8:70.
doi: 10.1186/1471-2334-8-70.

Healthcare-associated infections in pediatric cancer patients: results of a prospective surveillance study from university hospitals in Germany and Switzerland

Arne Simon  1 , Roland A Ammann, Udo Bode, Gudrun Fleischhack, Hans-Martin Wenchel, Dorothee Schwamborn, Chara Gravou, Paul-Gerhardt Schlegel, Stefan Rutkowski, Claudia Dannenberg, Dieter Körholz, Hans Jürgen Laws, Michael H Kramer
Affiliations
Multicenter Study

Healthcare-associated infections in pediatric cancer patients: results of a prospective surveillance study from university hospitals in Germany and Switzerland

Arne Simon et al. BMC Infect Dis. .

Abstract

Background: Pediatric cancer patients face an increased risk of healthcare-associated infection (HAI). To date, no prospective multicenter studies have been published on this topic.

Methods: Prospective multicenter surveillance for HAI and nosocomial fever of unknown origin (nFUO) with specific case definitions and standardized surveillance methods.

Results: 7 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.

Conclusion: Our 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.

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Figures

Figure 1
Figure 1
Device utilization rates (inpatient utilization days/inpatient days) for the different central venous access devices (CVADs) in the participating centers (C1-C7). CVC = conventional non-tunneled central venous access. Port = Port type CVAD with subcutaneously implanted reservoir. Broviac/Hickman = tunneled long term CVAD with subcutaneous cuff.
Figure 2
Figure 2
Incidence density of 263 healthcare associated infections and 464 nosocomial fevers of unknown origin in the participating centers (C1-C7). Q75 = 75. percentile excluding data from center 3 (allogenic transplantation unit).
Figure 3
Figure 3
Incidence density of HAI over time in Center 2 (48 months of surveillance divided in 8 consecutive periods of 6 months).
See this image and copyright information in PMC

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