Pediatrik kanserli hastalarda hastane infeksiyonları

Amaç: Çocuk kanser hastaları, uzun süre hastanede yatış, altta yatan hastalıkları ve uygulanan yoğun kemoterapilerden dolayı hayatı tehdit eden ağır sağlık hizmetleri ilişkin enfeksiyon (SHİE) açısından önemli bir risk grubu oluşturur. Bu çalışmada çocuk Hematoloji-Onkoloji (HO) kliniğinde bir yıl içinde yatan hastalarda SHİE değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Çocuk Hematoloji-Onkoloji (HO) kliniğinde (19 yataklı) bir yıl içinde yatan hasta- larda SHİE değerlendirildi. SHİE Hastalık Kontrol ve Önleme Merkezi (Centers for Diseases Control and Prevention) (CDC) kriterlerine göre tanımlandı. Bulgular: Bir yılda yatan 342 hastanın 44’ünde (%12.8) SHİE gelişti. Kırkdört hastada toplam 68 SHİE (hasta başına 1.54 SHİE) saptandı. SHİE oranı, 100 hasta yatışına göre 19.8 (68/342), 1000 hasta gününe göre ise 15.6 olarak bulundu. Üreyen etken- lere bakıldığında, Gram negatifler %43.4, Gram pozi- tifler %45.6, funguslar %11 oranında tespit edildi. SHİE tanısı alan 44 hastadan %57’si (n=25) akut len- foblastik lösemi (ALL), %18’i (n=8) non-Hodgkin len- foma, %9’u (n=4) akut myeloblastik lösemi (AML), %7’si (n=3) nöroblastom ve %9’u (n=4) diğer olgular- dı. Sadece ALL’li olgularda SHİE oranı ise 14.8/1000 hasta günü olarak bulundu. SHİE tanısı alan hastalar ortalama 73.6±53.4 gün (median=ortanca 53 gün) hastanede yattı. Hastaların hastaneye yatışlarının ortalama 33.9±28.3. gününde HE tanısı konuldu. SHİE tanısı alan 44 hastanın 10’u (%22.7) eksitus oldu. Eksitus olan hastaların %70’inde primer hasta- lığın yaygın tutulumu olup, terminal dönemde olan ve SHİE gelişen hastalardı. Toplam 68 SHİE atağında genel mortalite oranı %14.7 idi. Sonuç: Gelişmiş ülkelerle kıyaslandığında, SHİE sık- lık, mortalite oranları ile etkenlerin dağılımı ise benzer düzeyde bulundu. (J Pediatr Inf 2012; 6: 133-8)

Nosocomial ınfections in pediatric cancer patients

Objective: Pediatric cancer patients comprise an important risk group of nosocomial infections (NI) due to long hospital stay, underlying diseases and inten- sive chemotherapies. The aim of this study was to evaluate NI in the pediatric hemato-oncology clinic over a one year period. Material and Methods: Nosocomial infections in the pediatric hemato-oncology clinic (with 19 beds) were evaluated over a one-year period. Nosocomial infec- tion was defined according to the criteria of the Centers for Disease Control and Prevention (CDC). Results: Nosocomial infections were defined accord- ing to the CDC criteria. Of 342 admitted pediatric cancer patients, 44 (12.8%) developed NI. Sixty-eight NI occurred in 44 patients (1.54 NI per patient). The NI rate was found to be 19.8 per 100 discharge, and 15.6 per 1000 patient-days. Gram positive agents comprised 45.6%, Gram negative agents 43.4% and fungi 11% of all culture-positive NI. Of 44 children with NI, 57% (n=25) had acute lymphoblastic leuke- mia (ALL), 18% (n=8) had non-Hodgkins lymphoma, 9% (n=4) had acute myeloblastic leukemia (AML), 7% (n=3) had neuroblastoma, and 9% (n=4) had other solid tumors. NI was found at a rate of 14.8/1000 patient-days, specifically in children with ALL. The average hospital stay of children with NI was 73.6±53.4 days (median 53). NI was diagnosed on average after 33.9±28.3 days of hospitalization. Ten of 44 children with HI (22.7%) died. Seventy percent of these patients were in the terminal stage of their illness. The overall mortality rate was 14.7% in 68 cases of NI. Conclusion: Our results reveal that our center has comparable NI and mortality rates and a similar etio- logic agent distribution with regard to other devel- oped countries. (J Pediatr Inf 2012; 6: 133-8)

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