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

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...

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Autores principales: Akinboyo, Ibukunoluwa C, Young, Rebecca R, Spees, Lisa P, Heston, Sarah M, Smith, Michael J, Chang, Yeh-Chung, McGill, Lauren E, Martin, Paul L, Jenkins, Kirsten, Lugo, Debra J, Hazen, Kevin C, Seed, Patrick C, Kelly, Matthew S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141603/
https://www.ncbi.nlm.nih.gov/pubmed/32284949
http://dx.doi.org/10.1093/ofid/ofaa093
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author Akinboyo, Ibukunoluwa C
Young, Rebecca R
Spees, Lisa P
Heston, Sarah M
Smith, Michael J
Chang, Yeh-Chung
McGill, Lauren E
Martin, Paul L
Jenkins, Kirsten
Lugo, Debra J
Hazen, Kevin C
Seed, Patrick C
Kelly, Matthew S
author_facet Akinboyo, Ibukunoluwa C
Young, Rebecca R
Spees, Lisa P
Heston, Sarah M
Smith, Michael J
Chang, Yeh-Chung
McGill, Lauren E
Martin, Paul L
Jenkins, Kirsten
Lugo, Debra J
Hazen, Kevin C
Seed, Patrick C
Kelly, Matthew S
author_sort Akinboyo, Ibukunoluwa C
collection PubMed
description 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.
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spelling pubmed-71416032020-04-13 Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients Akinboyo, Ibukunoluwa C Young, Rebecca R Spees, Lisa P Heston, Sarah M Smith, Michael J Chang, Yeh-Chung McGill, Lauren E Martin, Paul L Jenkins, Kirsten Lugo, Debra J Hazen, Kevin C Seed, Patrick C Kelly, Matthew S Open Forum Infect Dis Major Article 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. Oxford University Press 2020-03-16 /pmc/articles/PMC7141603/ /pubmed/32284949 http://dx.doi.org/10.1093/ofid/ofaa093 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Akinboyo, Ibukunoluwa C
Young, Rebecca R
Spees, Lisa P
Heston, Sarah M
Smith, Michael J
Chang, Yeh-Chung
McGill, Lauren E
Martin, Paul L
Jenkins, Kirsten
Lugo, Debra J
Hazen, Kevin C
Seed, Patrick C
Kelly, Matthew S
Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients
title Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients
title_full Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients
title_fullStr Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients
title_full_unstemmed Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients
title_short Microbiology and Risk Factors for Hospital-Associated Bloodstream Infections Among Pediatric Hematopoietic Stem Cell Transplant Recipients
title_sort microbiology and risk factors for hospital-associated bloodstream infections among pediatric hematopoietic stem cell transplant recipients
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141603/
https://www.ncbi.nlm.nih.gov/pubmed/32284949
http://dx.doi.org/10.1093/ofid/ofaa093
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