Costs, Hospital Stays for BSIs Significant in Pediatric Oncology Outpatient Setting

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Ambulatory bloodstream infections (Amb-BSIs) in pediatric oncology and stem cell transplant (PO/SCT) patients result in significant health care charges and extended hospital admissions, according to findings of the second phase of a collaborative effort among children's hospitals to reduce the number of central-line–associated bloodstream infections (CLABSIs) in pediatric patients.1

In the first phase, interventions undertaken reduced CLABSIs by 28% over 3 years in pediatric inpatients at member facilities of the Children's Hospital Association Childhood Cancer and Blood Disorders Network. However, a large number of pediatric stem cell transplant and cancer patients undergo treatment in the ambulatory care setting. Therefore, this second phase focused on reducing CLABSIs originating in the outpatient setting between clinic visits.


For this study, researchers retrospectively analyzed data from 74 bloodstream infections in 61 outpatients that resulted in hospitalizations at Dana-Farber/Boston Children's. The infections occurred between January 1, 2012, and December 31, 2013, and 69% were classified as bloodstream infections.

Sixty-two hospitalizations were due to bloodstream infections. Median charges and hospital stay for these children were $36,000 and 6 days. The remaining hospitalizations included at least 1 other medical issue. Median charges and hospital stay for these children were $40,000 and 7 days.

Clinical outcomes included surgical removal of the central line in 43% of cases and transfers to the intensive care unit in 15% of cases. Four deaths occurred during hospitalizations, 3 of which were associated with the infections.

“This analysis suggests that efforts aiming at reducing rates of infections could result in substantial system savings, validating the need for increased efforts to prevent Amb-BSIs,” the authors concluded.


1. Wong Quiles CI, Gottsch S, Thakrar U, Fraile B, Billett AL. Health care institutional charges associated with ambulatory bloodstream infections in pediatric oncology and stem cell transplant patients. Pediatr Blood Cancer. doi: 10.1002/pbc.26194. [Epub ahead of print]

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