Prevalence of Hospital-acquired Infections in Pediatric Oncology Patients in a Third Level Public Hospital in Bolivia
Juan Pablo Rodriguez-Auad, Miguela CanizaAbstract
Background
Hospital-acquired infections (HAIs) occur within 72 hours of a patient being admitted. These infections increase cost of care, prolong hospital stay, increase antibiotic use, and cause a higher risk of mortality. Children with cancer are more vulnerable to these infections. The Hospital del Niño “Dr. Ovidio Aliaga Uria” in the city of La Paz, Bolivia, is the only public hospital in the city that cares for children with cancer. The pediatric hemato-oncology unit (PHOU) of this hospital has 25 beds for the care of children with cancer and 5 beds for outpatient chemotherapy. We present the report of HAIs at the PHOU during 2024 period.
Methods
From April to November 2024, active surveillance of HAIs was carried out daily at the PHOU, daily visits were made to patients admitted with clinical suspicion of an HAI, and the microbiology service was visited daily to see if there were any isolates in cultures. The data was collected in a sheet and uploaded to an Excel format on a monthly basis. CDC definitions were used for the diagnosis of HAIs. Each month, a report of the HAIs was made and feedback was given to the PHOU.
Results
During the 8 months of the study, 31 HAIs were identified, 97% were central line-associated bloodstream infections (CLABSIs) and there was only one case of Ventilator-associated pneumonia. In all cases, a germ was identified in blood culture, gram-negative bacilli (GNB) were the most frequent (94%) followed by gram-positive cocci (6%). No fungi were identified. The vast majority of GNBs were ESBL (84%) and in 77% of cases a carbapenem. The most frequently identified microorganisms were Burkholderia cepacia (48%) and Klebsiella pneumoniae (13%). The monthly average of HAI cases was 3.8 cases per month. The average age of children was 7.5 years and 100% of these patients had a central venous catheter installed at the time of infection. Of the total number of patients with HAI, 5 (16%) required intensive care management and there were no fatal cases related to HAI.
Conclusions
CLABSIs are the most frequent HAIs in the PHOU of our hospital, mainly due to GNBs. These infections are endemic in this unit, requiring broad-spectrum antibiotic management, and in some cases, intensive care management, which puts these patients at risk of having a fatal outcome. Prevention strategies such as the use of bundles to prevent CLABSIs are urgently needed in this PHOU.