Risk Factor Analysis of Bloodstream Infection in Pediatric Patients After Hematopoietic Stem Cell Transplantation

Abstract

Bloodstream infection (BSI) is a recognized cause of morbidity and mortality in children after hematopoietic stem cell transplantation (HSCT). However, there are limited reports on BSI after HSCT in pediatric patients in multiple centers. This study was a retrospective cohort analysis of consecutive patients who underwent allogeneic and autologous HSCT at the Department of Paediatrics, Hokkaido University Hospital, between 1988 and 2009; the Department of Paediatrics, Sapporo Hokuyu Hospital, between 2007 and 2009; and the Department of Paediatrics, Asahikawa Medical University, between 1989 and 2009. A total of 277 patients underwent HSCT during the study period. In this multicenter analysis, cases of BSI after HSCT were recorded in the early posttransplant period (within the first 100 d), and BSI was observed in 24 of 277 HSCT patients. Multivariate analysis showed that nonmalignant disease was an independent factor associated with BSI after HSCT (hazard ratio 6.3 for aplastic anemia or Wiskott-Aldrich syndrome patients; confidence interval, 1.4-12.8; P = 0.012). We conclude that aplastic anemia and Wiskott-Aldrich syndrome were the novel risk factors for BSI in pediatric patients after HSCT.

Incidence and risk factors of bacterial infections in children following autologous hematopoietic stem cell transplantation: Single‐center experience from Jordan

“…None of our GN isolates were resistant to piperacillin–tazobactam, which indicates that this therapy is sufficient empirical monotherapy in our patient population for a febrile episode following pediatric AHSCT. CONS was frequently isolated, which is likely related to the use of central lines in all our patients that is similar to what has been previously reported . Seventy‐two percent of the bacterial infections occurred prior to day 30 post‐transplant, which is likely related to the degree of neutropenia and mucosal damage due to the high‐dose chemotherapy.…”

“…The incidence of bacterial infection after HSCT varies from 8 to 41% with highest rates observed in the neutropenic phase or pre‐engraftment . Multiple risk factors have been identified including primary disease, the presence of comorbidities, stem cell source and dose, conditioning regimen, use of prophylactic antibiotics, duration of neutropenia, mucositis, and the use of central venous catheter . The majority of published studies concentrate on describing infections among adult patients.…”

In‐hospital mortality of hematopoietic stem cell transplantation among children with nonmalignancies: A nationwide study in the United States from 2000 to 2012

“…The most common cause of mortality after a nonmalignant HSCT has historically been infection, [16][17][18] common among which is bacterial infection during hospital stay, especially before engraftment is achieved. 19 On the other hand, we demonstrated an increase in admissions with infections by CMV or adenovirus, both of which almost tripled. These virus infections commonly occur in the early postengraftment period after HSCT among those with severely impaired cellular immunity.…”

“…Of note, our results showed a significant decrease in the admissions with bacteremia and those with infected vascular devices, and an insignificant, yet decreasing trend in those with severe sepsis/septic shock over the same period, which probably contributed to this improved in‐hospital mortality. The most common cause of mortality after a nonmalignant HSCT has historically been infection, common among which is bacterial infection during hospital stay, especially before engraftment is achieved …”

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…20 In pediatric populations, non-malignant diseases are associated with higher BSI risk than malignant diseases. 5,35 …”