title: Healthcare-Associated Infections at a Children's Cancer Hospital, 1983-2008.
abstract: BACKGROUND
  Little is known about the incidence and etiology of healthcare-associated infections in immunosuppressed children.
  
  
  METHODS
  Data collected prospectively between 1983 and 2008 were used to analyze changes in the rate, types of infection, and infecting organisms over time in patients treated at a children's cancer hospital. Neutropenia was evaluated as a risk factor.
  
  
  RESULTS
  Over the 26-year study period, 1986 healthcare-associated infections were identified during 1653 hospitalizations. The infection rate decreased significantly from 5.6 to 2.0 infections per 100 discharges (P < .01) and from 9.0 to 3.7 infections per 1000 patient-days (P < .01). Bloodstream infections were the most common type of infection (32.7% of all infections). Staphylococci (46.4% of Gram-positive bacteria), Escherichia coli (36.7% of Gram-negative bacteria), and Candida spp. (68.7% of fungi) were the most common pathogens isolated. An absolute neutrophil count (ANC) nadir <100 per mm(3) was significantly associated (P < .0001) with an increased rate of infections compared with higher ANC nadirs.
  
  
  CONCLUSIONS
  Despite a steady expansion in hospital capacity and patient encounters over the last 3 decades, rates of healthcare-associated infections decreased significantly at our hospital. These data suggest that sustained decreases in the rate of healthcare-associated infections in immunosuppressed children are possible. An ANC <100 per mm(3) is a risk factor for healthcare-associated infections in this population.
authors.affiliation: Departments of Infectious Diseases Infection Control and Prevention jon.mccullers@stjude.org.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: McCullers
authors.affiliation: Infection Control and Prevention.
authors.forename: Bonnie F
authors.initials: BF
authors.lastname: Williams
authors.affiliation: Biostatistics.
authors.forename: Song
authors.initials: S
authors.lastname: Wu
authors.affiliation: Biostatistics.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Smeltzer
authors.affiliation: Infection Control and Prevention.
authors.forename: Bobby G
authors.initials: BG
authors.lastname: Williams
authors.affiliation: Pathology.
authors.forename: Randall T
authors.initials: RT
authors.lastname: Hayden
authors.affiliation: Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.affiliation: Pathology Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.affiliation: Departments of Infectious Diseases.
authors.forename: Walter T
authors.initials: WT
authors.lastname: Hughes