Surveillance of Infections in a Pediatric Oncologic Unit and Bone Marrow Transplantation Unit in a Tertiary Public Hospital in Jalisco, Mexico.

Abstract

Background. Infections are the most frequent complication in children with cancer and those undergoing bone marrow transplantation (BMT). Patient with these risk factors have higher morbidity and mortality rates in low-to middle-income countries including Mexico than in higher income countries. Since 2013, a program for the better care and prevention of infection was implemented in the pediatric oncology and BMT units of Hospital Civil de Guadalajara which include a prospective surveillance of infections and their risk factors among children with cancer and BMT. We aimed to identify the frequency of infections in this population and their outcome. Methods. Patients of the pediatric oncology and BMT unit admitted between May 2014 and December 2015 at our institution and developed infections were analyzed. Results. We identified 360 infections in 424 patients in 1,594 admissions in onco-logic pediatric unit, and 6 infections in 14 patients admitted in the BMT unit. The infection rate among pediatric patients with cancer was 22.6/100 admissions and 43/100 among pediatric patients undergoing to BMT. Episodes of febrile neutropenia presented in 67% (291/424) of children with cancer. In the oncologic unit, bloodstream infections (BSI) were the most common (119 episodes, 33.1%), followed by pneumonias (107 episodes, 30%) and urinary tract infections (55 episodes, 15.3%). In the BMT unit, BSIs associated to catheters were most prevalent (6 episodes, 43%). Together, on-cologic and BMT patients, Gram-negative infections were seen in 83 (70%) patients with BSI, followed by Gram-positive infection in 48 (40.3%), and fungi in 7 (6%) cases. Pseudomonas aeruginosa and Escherichia coli were the most common Gram-negative pathogens and coagulase negative staphylococci were the most common Gram-positive microorganisms isolated. Infection-associated mortality rate among pe-diatric oncology patients was 9.4% (34/360), and among children undergoing to BMT was 22.2% (2/9). Conclusion. The high rates of infection and infectious mortality among oncologic patients and BMTs require further studies to identify risk factors. Identified risk factors must be addressed to improve better survival rates of children cancer and BMT in our hospital.