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Profile of Nosocomial Infections among Children with Acute Lymphoblastic Leukemia

Journal 2014 Vol.15 No.2
Paul Candice Ellen M. Eler, MD, Ma. Ysabel G. Lesaca-Medina, MD, Cecilliene Acosta, MD
Nosocomial Infection, Acute Lymphoblastic Leukemia, Gram negative infections, Pseudomonas infections, Burkholderia infections
Objectives: The study aimed to determine the frequency and clinical profile of nosocomial infections among pediatric patients with Acute Lymphoblastic Leukemia (ALL) admitted at the Philippine General Hospital from January 2010 to December 2011.

Methodology: This is a descriptive cross sectional study invollving the review of medical records of pediatric patients with ALL under the charity service of the Section of Pediatric Hematology and Oncology of Philippine General Hospital (PGH). The frequency, clinical presentation, outcome, causes of death and isolated organisms from sterile sites were determined. Fischerís Exact test was used to assess correlation between variables with Gram-negative bacterial infection and moratality.

Results: There were 80 documented nosocomial infections among 45 pediatric patients with ALL. The majority presented initially with fever (50%) and 37 (82%) had neutropenia. Blood stream infections were present in 33 (73%) out of 45 pediatric ALL patients. Gram-negative organisms (76%), particularly Pseudomonas putida (33%), Pseudomonas aeruginosa (12%) and Burkholderia pseudomallei (12%) were isolated in majority of patients. About 42.2% of the 45 patients had resolution of the infection and 26.7% resulted to death primarily caused by septic shock in 7 (58.3%) of the 12 patients identified. Presence of fever (p- value 0.011, RR 2.1094) was associated with presence of Gram-negative bacteria at 5% level of significance and with 2.109 times more risk to having a gram-negative infection. There was no significant correlation between mortality and symptoms of infection.

Conclusion: Nosocomial infections remain to be significant cause of morbidity and death among pediatric patients with ALL. Gram negative infections were the most common cause of sepsis in these patients. One fourth of the patients with nosocomial infections died.
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Cecilia Maramba-Lazarte, MD, MScID

Nancy Bermal, MD
Arlene Dy-Co, MD

Gyneth Bibera, MD
Mary Anne Bunyi, MD
Elizabeth Gallardo, MD
Jonathan Lim, MD
Xenia Cathrine Fabay , MD
Fatima Jimenez , MD
Nanette Cuady-Madrid, MD
Carmina Arriola, MD
Arlene S. Dy-Co, MD
Maria Estrella Balao-Litam, MD, MBA-H
Belle Ranile, MD
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Rea Uy-Epistola