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. 2020 Mar 16;7(4):ofaa093.
doi: 10.1093/ofid/ofaa093. eCollection 2020 Apr.

Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients

Ibukunoluwa C Akinboyo  1 , Rebecca R Young  1 , Lisa P Spees  2   3 , Sarah M Heston  1 , Michael J Smith  1 , Yeh-Chung Chang  1 , Lauren E McGill  1   4 , Paul L Martin  4 , Kirsten Jenkins  1 , Debra J Lugo  1 , Kevin C Hazen  5 , Patrick C Seed  6 , Matthew S Kelly  1
Affiliations

Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients

Ibukunoluwa C Akinboyo et al. Open Forum Infect Dis. .

Abstract

Background: Children undergoing hematopoietic stem cell transplantation (HSCT) are at high risk for hospital-associated bloodstream infections (HA-BSIs). This study aimed to describe the incidence, microbiology, and risk factors for HA-BSI in pediatric HSCT recipients.

Methods: We performed a single-center retrospective cohort study of children and adolescents (<18 years of age) who underwent HSCT over a 20-year period (1997-2016). We determined the incidence and case fatality rate of HA-BSI by causative organism. We used multivariable Poisson regression to identify risk factors for HA-BSI.

Results: Of 1294 patients, the majority (86%) received an allogeneic HSCT, most commonly with umbilical cord blood (63%). During the initial HSCT hospitalization, 334 HA-BSIs occurred among 261 (20%) patients. These were classified as gram-positive bacterial (46%), gram-negative bacterial (24%), fungal (12%), mycobacterial (<1%), or polymicrobial (19%). During the study period, there was a decline in the cumulative incidence of HA-BSI (P = .021) and, specifically, fungal HA-BSIs (P = .002). In multivariable analyses, older age (incidence rate ratio [IRR], 1.03; 95% confidence interval [CI], 1.01-1.06), umbilical cord blood donor source (vs bone marrow; IRR, 1.69; 95% CI, 1.19-2.40), and nonmyeloablative conditioning (vs myeloablative; IRR, 1.85; 95% CI, 1.21-2.82) were associated with a higher risk of HA-BSIs. The case fatality rate was higher for fungal HA-BSI than other HA-BSI categories (21% vs 6%; P = .002).

Conclusions: Over the past 2 decades, the incidence of HA-BSIs has declined among pediatric HSCT recipients at our institution. Older age, umbilical cord blood donor source, and nonmyeloablative conditioning regimens are independent risk factors for HA-BSI among children undergoing HSCT.

Keywords: antifungal prophylaxis; conditioning regimen; mortality; umbilical cord blood.

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Figures

Figure 1.
Figure 1.
Incidence of pediatric HA-BSI among HSCT recipients (1997–2016). The number of HA-BSIs per year at risk during the study period is shown by HA-BSI category. The incidence of HA-BSIs (P = .021) and fungal HA-BSIs (P = .002) decreased over time. The incidence of gram-positive bacterial HA-BSIs also declined (P = .102), whereas the incidence of gram-negative bacterial HA-BSIs did not change during the study period (P = .583). Abbreviations: HA-BSI, hospital-associated bloodstream infection; HSCT, hematopoietic stem cell transplantation.
See this image and copyright information in PMC

References

    1. Dandoy CE, Haslam D, Lane A, et al. Healthcare burden, risk factors, and outcomes of mucosal barrier injury laboratory-confirmed bloodstream infections after stem cell transplantation. Biol Blood Marrow Transplant 2016; 22:1671–7. - PMC - PubMed
    1. Almyroudis NG, Fuller A, Jakubowski A, et al. Pre- and post-engraftment bloodstream infection rates and associated mortality in allogeneic hematopoietic stem cell transplant recipients. Transpl Infect Dis 2005; 7:11–7. - PubMed
    1. Spees L, Martin PL, Kurtzberg J, et al. Reduction in mortality after umbilical cord blood transplantation in children over a 20-year period (1995–2014). Biol Blood Marrow Transplant 2019; 25(4):756–63. - PMC - PubMed
    1. Gooley TA, Chien JW, Pergam SA, et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 2010; 363:2091–101. - PMC - PubMed
    1. Mikulska M, Del Bono V, Bruzzi P, et al. Mortality after bloodstream infections in allogeneic haematopoietic stem cell transplant (HSCT) recipients. Infection 2012; 40:271–8. - PubMed