title: Microbiology, infection control and infection related outcome in pediatric patients in an oncology center in Eastern India: Experience from Tata Medical Center, Kolkata.
abstract: BACKGROUND
  Infection is a major determinant in the outcome of patients with cancer.
  
  
  OBJECTIVE
  The aim was to know the epidemiology and outcome of patients with cancer in a cancer care center in Eastern India.
  
  
  METHODS
  Retrospective study of pediatric patients in Tata Medical Center, Kolkata, India.
  
  
  METHODS
  Patients (n = 262) between the age group of 0 and 18 years were reviewed for infections and infection-related outcome (January to December 2013).
  
  
  METHODS
  Modified Wald method was used to determine confidence interval of proportions.
  
  
  RESULTS
  Gram-negative bacteria were found to be the most common cause of bloodstream infections (BSIs) (56.4%), followed by Gram-positive cocci (34.5%), and Candida species (9.1%). Carbapenem-resistance was noted among 24% of Gram-negative bacilli (GNB), and extended-spectrum beta-lactamase among 64% of GNBs. A single case of Vibrio cholerae septicemia was also noted. No case of vancomycin-resistant Enterococcus was observed, whereas only two cases of methicillin-resistant Staphylococcus aureus bacteremia (1/3 of all Staphylococcus aureus bacteremia) were detected. Escherichia coli, followed by Klebsiella, Pseudomonas, and Acinetobacter were the predominant organisms detected in BSIs. Among Candida spp. BSIs no resistance to caspofungin, amphotericin B, Voriconazole was noted. Candida tropicalis was the most common isolate, and 1 isolate of Candida glabrata showed dose-dependent sensitivity to fluconazole. Three out of 25 patients died of multi-drug resistant Gram-negative bacteria (12%) in 2013. Seventeen patients had radiological evidence of invasive fungal infections (no mortality was noted).
  
  
  CONCLUSIONS
  Periodic review of infection-related data, as well as infection control practices, is essential to optimize clinical outcome in patients with pediatric malignancies.
authors: Department of Pediatric Oncology, Tata Medical Center, Kolkata, West Bengal, India.
authors: Arpita
authors: A
authors: Bhattacharyya
authors: Shekhar
authors: S
authors: Krishnan
authors: Vaskar
authors: V
authors: Saha
authors: Gaurav
authors: G
authors: Goel
authors: Sanjay
authors: S
authors: Bhattacharya
authors: Lalawmpuia
authors: L
authors: Hmar
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000935:Antifungal Agents / Q000494:pharmacology; D002173:Cancer Care Facilities; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents