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Health care associated infections decreased among immunosuppressed children
Health care-associated infection rates among a large cohort of immunosuppressed children decreased more than 50% during a recent 26-year period, according to study results.
Researchers from St. Jude Children’s Research Hospital, Memphis, Tenn., aimed to investigate the incidence and etiology of infections in this patient population using findings collected prospectively at their cancer center between 1983 and 2008.
Using neutropenia as a risk factor, the rate, types of infection and infecting organisms over time were evaluated.
The final analysis included 1,986 health care-associated infections linked to 1,653 hospitalizations.
A significant decrease was observed during the 26-year period, from 5.6 to two infections per 100 discharges (P<.01). Similarly, a decrease from nine to 3.7 infections per 1,000 patient-days also was observed (P<.01).
The most common type of infections were bloodstream infections, which accounted for 32.7% of all infections. The most common pathogens isolated were Staphylococci (46.4% of gram-positive bacteria), Escherichia coli (36.7% of gram-negative bacteria) and Candida spp. (68.7% of fungi), according to the results.
The researchers also noted a significant link between an absolute neutrophil count nadir of less than 100/mm3 and an increased infection rate compared with higher absolute neutrophil count nadirs.
“These data suggest that sustained decreases in the rate of health care-associated infections in immunosuppressed children are possible,” they wrote. However, they added that a lower absolute neutrophil count nadir remains a risk factor for health care-associated infections.
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The continued evolution of our understanding of risks for specialized patient populations is an important aspect for our continued management of our patients and the establishment of guidelines for the best care of these ever more complex clinical scenarios. The new analysis from a specialized children’s cancer hospital further defines the significant risk of HAI in these subgroups of patients. The significance of HAI by location, region of the country for major opportunistic pathogens and the individual facilities’ hospital-acquired pathogen risk continues to be an important component of these assessments. This new paper allows for generalization of key principles and risk factors that are useful for all clinicians. New areas of patient safety and best practices, such as the antimicrobial stewardship programs and hand hygiene initiatives are promising initiatives as we strive to “get to zero” on patient safety metrics.
Richard F. Jacobs, MD
Infectious Diseases in Children Chief Medical Editor
Disclosure: Dr. Jacobs reports no relevant financial disclosures.
