Epidemiological surveillance of healthcare-associated infections in a pediatric hematopoietic stem cell transplantation unit in south Brazil.

Amancio, Luana; Garcia Giamberardino, Heloisa Ihle; Ferreira, Eurípedes; Matucheski, Biana; Luisa Garcia Giamberardino, Ana

BACKGROUND Pediatric hematopoietic stem cell transplantation (HSCT) recipients represent a vulnerable population in regard to health care-associated infections (HAI) with a differentiated profile of etiologic agents.1,2 There are few reports in the literature regarding HAI in the pediatric population submitted to HSCT. METHODS This is a retrospective study conducted in a pediatric HSCT unit in Curitiba, Brazil between February 2013 and December 2017 that evaluated 109 pediatric patients. The variables analyzed were: age, gender, baseline disease, type of transplantation, infection topography, etiologic agent, time of HAI occurrence, antimicrobial prophylaxis, period of neutropenia, length of stay, and outcomes. RESULTS Out of 113 HSCT procedures, 91 (83.5%) were allogenic and 18 autologous (16.5%). The mean age of the patients was 7.9 years, with an median of 8.1 years (4.0 months-17.3 years); 71 (65.1%) were male; 55 (50.5%) presented with an oncologic diagnosis, 32 (29.4%) with a hematological diagnosis, 17 (15.6%) with immunodeficiencies, and 5 (4.6%) with other causes. During hospitalization after HSCT, 86 episodes of HAI were detected in 66 patients, with an infection density of 16.5 infections/1000 patient days, 86% of which occurred after allogeneic transplants, appearing, on average, 15.3 days after transplantation. The main topographies were bloodstream infection (BSI), with 24 (27.9%) cases, and central line-associated bloodstream infection (CLABSI), with 11 (12.8%). Gram-positive bacteria predominated in cultures and HAI was more frequent in patients diagnosed with immunodeficiencies and other non-oncologic and non-hematologic conditions. Among the Gram-positive bacteria, Staphylococcus epidermidis was the main agent identified (77.7%), possibly due to colonization. However, Gram-negative bacteria, with a resistance profile, comprised 40% of the cases of bacterial infections, most of them represented by Klebsiella pneumoniae (66.6%). Out of the 66 patients who presented HAI, 59 patients (89.4%) were discharged and 7 (10.6%) died. CONCLUSION The main topographies were CLABSI and BSI. Patients with immunodeficiencies presented a higher risk for HAI. Staphylococcus epidermidis was the main agent identified. However, Klebsiella pneumoniae posed a higher risk for Pediatric Intensive Care Unit admission and death.