Abstract
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. 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. 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)." 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. 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. 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. 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)." 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.>
