title: The Centers for Disease Control and Prevention definition of mucosal barrier injury-associated bloodstream infection improves accurate detection of preventable bacteremia rates at a pediatric cancer center in a low- to middle-income country.
abstract: BACKGROUND
  The US National Healthcare Safety Network has provided a definition of mucosal barrier injury-associated, laboratory-confirmed bloodstream infection (MBI-LCBI) to improve infection surveillance. To date there is little information about its influence in pediatric oncology centers in low- to middle-income countries.
  
  
  OBJECTIVE
  To determine the influence of the definition on the rate of central line-associated bloodstream infection (CLABSI) and compare the clinical characteristics of MBI versus non-MBI LCBI cases.
  
  
  METHODS
  We retrospectively applied the National Healthcare Safety Network definition to all CLABSIs recorded at a pediatric oncology center in Tijuana, Mexico, from January 2011 through December 2014. CLABSI events were reclassified according to the MBI-LCBI definition. Clinical characteristics and outcomes of MBI and non-MBI CLABSIs were compared.
  
  
  RESULTS
  Of 55 CLABSI events, 44% (24 out of 55) qualified as MBI-LCBIs; all were MBI-LCBI subcategory 1 (intestinal flora pathogens). After the number of MBI-LCBI cases was removed from the numerator, the CLABSI rate during the study period decreased from 5.72-3.22 infections per 1,000 central line days. Patients with MBI-LCBI were significantly younger than non-MBI-LCBI patients (P = .029) and had a significantly greater frequency of neutropenia (100% vs 39%; P = .001) and chemotherapy exposure (87% vs 58%; P = .020) and significantly longer median hospitalization (34 vs 23 days; P = .008).
  
  
  CONCLUSIONS
  A substantial proportion of CLABSI events at our pediatric cancer center met the MBI-LCBI criteria. Our results support separate monitoring and reporting of MBI and non-MBI-LCBIs in low- to middle-income countries to allow accurate detection and tracking of preventable (non-MBI) bloodstream infections.
authors.affiliation: Department of Hematology/Oncology, Hospital General de Tijuana, Tijuana, Mexico; Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego-Rady Children's Hospital, San Diego, CA.
authors.forename: Dara
authors.initials: D
authors.lastname: Torres
authors.affiliation: Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Miriam L
authors.initials: ML
authors.lastname: González
authors.affiliation: Department of Hematology/Oncology, Hospital General de Tijuana, Tijuana, Mexico; Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego-Rady Children's Hospital, San Diego, CA.
authors.forename: Adriana
authors.initials: A
authors.lastname: Loera
authors.affiliation: Department of Hematology/Oncology, Hospital General de Tijuana, Tijuana, Mexico; Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego-Rady Children's Hospital, San Diego, CA.
authors.forename: Marco
authors.initials: M
authors.lastname: Aguilera
authors.affiliation: School of Public Health, University of Memphis, Memphis, TN.
authors.forename: George
authors.initials: G
authors.lastname: Relyea
authors.affiliation: Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of California San Diego-Rady Children's Hospital, San Diego, CA.
authors.forename: Paula
authors.initials: P
authors.lastname: Aristizabal
authors.affiliation: Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN; International Outreach Program, St Jude Children's Research Hospital, Memphis, TN. Electronic address: miguela.caniza@stjude.org.
authors.forename: Miguela A
authors.initials: MA
authors.lastname: Caniza
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D003906:Developing Countries; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico; D009092:Mucous Membrane / Q000293:injuries*; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D014481:United States
keywords: Central venous access device; Developing countries, children, malignancies; Healthcare-associated; Length of stay