title: Healthcare-associated infections among pediatric oncology patients in Pakistan: risk factors and outcome.
abstract: BACKGROUND
  Pediatric oncology patients are at increased risk of contracting healthcare-associated infections (HAIs), which are responsible for increased morbidity and mortality rates as well as treatment costs.  This study aimed to identify the frequency of HAIs among pediatric oncology patients and their outcome.
  
  
  METHODS
  Pediatric oncology patients admitted between January 2009 and June 2010 in a pediatric ward at Aga Khan University Hospital, Karachi, Pakistan, who developed HAIs, were analyzed.
  
  
  RESULTS
  A total of 90 HAIs were identified in 32 patients in 70 admissions. The HAI rate among pediatric oncology patients was 3.1/100 admission episodes. Bloodstream infections (63 episodes, 90.0%) were the most common, followed by urinary tract infection (two episodes, 2.9%). Gram-positive infections were seen in 54 (60%) patients, followed by Gram-negative infection in 34 (37.8%), and fungi in 2 (2.8%) cases. Coagulase negative staphylococci was the most common Gram-positive and Escherichia coli and Pseudomonas aeruginosa were most common Gram-negative infections. Mortality rate among pediatric oncology patients who developed HAIs was 12.5% (4/32). Total parental nutrition use and length of stay longer than 30 days were the identified risk factors associated with increased mortality among pediatric oncology patients who developed HAIs.
  
  
  CONCLUSIONS
  We report an HAI rate among pediatric oncology patients of 3.1/100 admission episodes with a mortality rate of 12.5% in Pakistan. Further studies should be done, especially in the developing world, to identify the risk factors associated with increased mortality among pediatric oncology patients so that adequate measures can be taken to reduce the mortality among these patients.
authors.affiliation: Department of Pediatric and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan. naveed.rehman@aku.edu
authors.forename: Naveed-ur-Rehman
authors.initials: NU
authors.lastname: Siddiqui
authors.forename: Rabia
authors.initials: R
authors.lastname: Wali
authors.forename: Anwar-ul
authors.initials: AU
authors.lastname: Haque
authors.forename: Zehra
authors.initials: Z
authors.lastname: Fadoo
mesh_terms: D000293:Adolescent; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality; D009369:Neoplasms / Q000150:complications*; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome