A previous study of pediatric patients with neoplastic diseases in Germany by Simon et al. [10] found a rate of NIs of 5.2 cases per 100 admittances and of 10.8 cases per 1000 days of hospitalization, which is similar to the results obtained by our study. A study of Urrea et al. [11] among pediatric patients with neoplastic diseases in Spain found an NI rate of 1.77 cases per 100 Tubacin CAS days of hospitalization. The incidence of NIs in our study was relatively low in comparison to the study of Urrea et al. This may be because our study excluded patients with fever of unknown origin and those who had viral infections. In addition, in our study patients appeared to have lower rates of central venous catheterizations than patients in previous studies [5, 10, 11].

Patients with ALL who represented 59% of the sample population had the highest NI rate (41.3%) in our study. Since the percentage of ALL patients in our study was higher than that reported in other studies [10, 11], it could represent a skewed population. In regards to sites of NIs, most infections in our study occurred in the blood stream (30.5%), as in other studies by Simon et al. [10] (52.5%) and Urrea et al. [11] (55.5%). Regarding causal organisms of NIs, studies from Eastern countries found that gram-negative bacteria were most common, like in our study. Our study found 47.1% gram-negative bacteria and 29.4% gram-positive bacteria while the study by Frank et al. [12] in Israel from 1992 to 2001, which focused particularly on bacteremia in pediatric wards, found 54.3% gram-negative bacteria and 36.6% gram-positive bacteria.

However, our study focused on children with neoplastic diseases while Frank’s et al. study included the general pediatric population, including intensive care units. Therefore this comparison might not be completely valid. In contrast, studies from European countries were more likely to report gram-positive bacteria to be more common. For example, the study by Simon et al. [10] found up to 83.3% gram-positive and 11.1% gram-negative bacteria, and the study by Urrea et al. [11] reported up to 78.6% gram-positive bacteria. The higher rate of gram-positive bacteria as causal organisms for NIs in European countries could be due to the fact that in European countries central venous catheterization is more common than in Eastern countries, such as in Thailand.

In addition, in our study we found 3 cases of Salmonella enteritidis infections. Salmonella enteritidis is unlikely to be a causal organism of NIs since it is normally found in community settings. We think that these patients may have been colonized with this organism outside the hospital and then developed symptoms when their immunity level Carfilzomib was low after chemotherapy. Furthermore, our study found that fungal infections accounted for 14.7% of infections, while in the previous two studies by Simon et al. [10] and Urrea et al.