Nosocomial infections among pediatric hematology/oncology patients: Results of a prospective incidence study Mireya Urrea, MD, a Susana Rives, MD, b Ofelia Cruz, MD, PhD, b Albert Navarro, c Juan Jose ´ Garcı ´a, MD, d and Jesu ´s Estella, MD b Barcelona, Spain Background: Nosocomial infections (NI) are an important clinical complication in adult and children patients at the different hospital wards. NI cause considerable morbidity and mortality and are associated with prolonged hospital stay and increased health care costs. Objective: The objective of this study was to describe the incidence of NI in pediatric patients with neoplastic disease as a first step toward improving infection control policies. Methods: A prospective surveillance study from March through May 2001 was performed in the pediatric hematology/oncology unit at the University Hospital in Barcelona. The Centers for Disease Control and Prevention criteria were used as standard definition for NI. NI rates were calculated as a density incidence rate (per 100 patient-days). Results: Fifty-one patients were admitted during the study period. Twelve patients had a total of 18 NI. The incidence of NI was 1.77 per 100 patient-days. Patients with acute lymphoblastic leukemia had the highest NI rate (2.71 per 100 patient-days). The most frequent episodes of NI were bacteremia (55.5%) and fever of unknown origin (16.6%). The most frequently isolated microorganisms were gram-positive bacteria (78.6%). Coagulase-negative Staphylococci were the most common isolates in bacteremias (70%). The extrinsic risk factors related with the highest incidence rates of NI per 100 patient-days were central venous catheterization (1.7 infections) and parenteral nutrition (3.2 infections). Conclusions: Extrinsic risk factors associated with NI have been identified in this high-risk population. These findings suggest the need to evaluate the infection control measures to reduce the morbidity and mortality in a hematology/oncology unit. (Am J Infect Control 2004;32:205-8.) Severe and prolonged immunosuppression in hematology/oncology patients has multifactorial etiologies. Health care improvement has allowed increasingly aggressive management in diagnostic and therapeutic procedures. These intensified treat- ments have been associated with severe neutropenia, which has been identified as the most important risk factor for infectious complications in patients with neoplastic diseases. 1–3 There are few studies available about the incidence of nosocomial infections in pediatric patients and scarce comparative data re- ported in pediatric hematology/oncology units. 4,5 The aim of this study was to describe the incidence of NI in patients with neoplastic diseases, and the possible risk factors associated with it, as a first step toward improving infection control policies in a pedi- atric hematology/oncology unit. METHODS Patients and setting The pediatric hematology/oncology department at the Sant Joan de De ´u University Hospital in Barcelona includes a 16-bed inpatient unit and an outpatient unit with 8 beds. Patients from 0 to 18 years of age are attended to in this unit. With regard to antibiotic prophylaxis, all our oncologic patients receive Pneumocistis carinii pro- phylaxis with trimetoprim/sulfametoxazol 3 times weekly. We do not perform intestinal decontamination in neutropenic patients. Fungal prophylaxis with oral fluconazol is only carried out in those patients in which prolonged neutropenia is expected. From Quality Service-Infection Hospital Program a ; Department of Pediatric Hematology and Oncology b ; Biostatistic Unit-Universitat Auto `noma de Barcelona c ; and Service of Pediatric, d Hospital Sant Joan de De ´u, Barcelona, Spain. Reprint requests: Mireya Urrea Ayala, MD, Quality Service-Infection Hospital Program, Hospital Sant Joan de De ´u Pg, Sant Joan de De ´u, 2, 08950 Esplugues, Barcelona, Spain. 0196-6553/$30.00 Copyright ª 2004 by the Association for Professionals in Infection Control and Epidemiology, Inc. doi:10.1016/j.ajic.2003.10.013 205