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[Nosocomial infections in immunocompromised children]
M D Tabone1, H Vu Thien, D Moissenet
1Service d'hématologie et d'oncologie pédiatrique, hôpital d'enfants Armand-Trousseau, 26 avenue du Dr-A. Netter, 75012 Paris, France. hemato-onco-ped.trousseau@trs.ap-hop-paris.fr
Insights
Immunocompromised children face high risks of hospital-acquired infections (nosocomial infections), leading to severe illness and death. Key factors include neutropenia and central venous catheters, with fungal infections posing a significant threat.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Immunocompromised Hosts
Context:
- Immunocompromised children, particularly those in pediatric oncology, are highly susceptible to nosocomial infections, with reported prevalence ranging from 10-20%.
- Predisposing factors include neutropenia, central venous catheters, corticosteroid therapy, and environmental factors like hospital construction, especially for invasive aspergillosis.
- The management of febrile neutropenia requires consideration of patient history and departmental microbiology, with Gram-positive infections being predominant but fungal infections remaining a major concern.
Purpose:
- To review the epidemiology and management challenges of nosocomial infections in various immunocompromised pediatric populations.
- To highlight specific risks and pathogens associated with different conditions such as pediatric oncology, organ transplant recipients, and HIV-infected children.
- To emphasize the need for prospective studies on adapted preventive infection control strategies.
Summary:
- Nosocomial infections present a significant threat to immunocompromised children, contributing to substantial morbidity and mortality.
- Risk factors are diverse, including medical interventions (neutropenia, catheters) and environmental exposures, with varying pathogens across patient groups (e.g., Gram-positives, fungi, CMV).
- Effective management necessitates tailored approaches based on individual patient factors and local microbial patterns, underscoring the need for improved infection control.
Impact:
- Informs clinical practice regarding the prevention and management of hospital-acquired infections in vulnerable pediatric populations.
- Identifies critical areas for future research in infection control strategies for immunocompromised children.
- Contributes to reducing the burden of nosocomial infections, improving outcomes for children undergoing cancer treatment, organ transplantation, or living with HIV.
Abstract:
Immunocompromised children are at high risk for developing nosocomial infections which may cause significant morbidity and mortality in this population. In paediatric oncology, reported prevalence of nosocomial infections varies from 10 to 20%. Major predisposing factors are neutropenia, central venous catheter, corticosteroid therapy and hospital construction or renovation for invasive aspergillosis. The management of patients with febrile neutropenia should take into account the previous history of infection and the microbiologic environment of each department. Nowadays, Gram positives infections are predominant, but fungal infections remain a major threat. In organ transplant recipients, wound infections are the main early problems, followed by viral infections often due to the donor CMV seropositivity. In HIV-infected children, nosocomial infections are difficult to define, and can implicate unusual pathogens. In general, adapted preventive infection control strategy warrants prospective studies.